deamino-arginine-vasopressin and Reperfusion-Injury

Retrospective studies suggest that donor desmopressin (DDAVP) treatment improves renal transplant outcome. The present study tests the hypothesis that desmopressin neutralizes the graft's endothelium from proinflammatory angiopoietin 2 containing Weibel-Palade bodies in the donor, resulting in reduced Weibel-Palade body release at the time of reperfusion in the recipient.. Using rat models, we examined the influence of desmopressin treatment on the expression of vasopressin 2 receptors and adhesion molecules in brain-dead donors, with renal function examined in allogeneic recipients. The influence of desmopressin on the expression of adhesion molecules also was tested in vitro.. Vasopressin 2 receptors were restricted to collecting ducts and distal tubules and only scarcely found in the renal vasculature. Vasopressin 2 receptor expression was down-regulated in brain-dead rats by desmopressin. Renal expression of vascular cellular adhesion molecule 1 and intercellular adhesion molecule 1 were significantly reduced in these rats. In contrast, angiopoietin 2 did not influence the expression of adhesion molecules in in vitro cultured endothelial cells after tumor necrosis factor ? stimulation. Donor desmopressin treatment improved neither renal function nor histology in allogeneic renal transplant recipients.. Our data do not support the hypothesis that the clinically observed salutary effect of desmopressin is mediated by depletion of Weibel-Palade bodies in renal allografts.

Topics: Angiopoietin-2; Animals; Cells, Cultured; Cold Ischemia; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Endothelial Cells; Human Umbilical Vein Endothelial Cells; Humans; Intercellular Adhesion Molecule-1; Kidney; Kidney Transplantation; Male; Models, Animal; Rats, Inbred F344; Rats, Inbred Lew; Receptors, Vasopressin; Reperfusion Injury; Time Factors; Transplantation, Homologous; Tumor Necrosis Factor-alpha; Vascular Cell Adhesion Molecule-1; Warm Ischemia; Weibel-Palade Bodies

Living donor liver transplantation reduces time and mortality on the waiting list. Bleeding is a serious complication; however, "overcorrection" of coagulopathy may lead to hepatic artery thrombosis. We report a case where desmopressin (DDAVP) was used in the management of persistent postreperfusion bleeding (44 red blood cell units transfused). After 1 dose of DDAVP, bleeding improved significantly and the recipient had an unremarkable recovery. DDAVP should be considered for persisting bleeding after correcting common coagulation abnormalities where complexity of the anastomosis may preclude the use of more aggressive procoagulant drugs in liver transplantation.

Topics: Deamino Arginine Vasopressin; Hemostatics; Humans; Liver; Liver Transplantation; Male; Middle Aged; Postoperative Hemorrhage; Reperfusion Injury