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Changes in hepatic microcirculation and histomorphology in brain-dead organ donors: an experimental study in rats
Objective:
To assess the effect of brain death on hormonal homeostasis, hepatic microcirculation, and histomorphology in organ donors.
Design:
Prospective randomised experimental study.
Setting:
Institute for Surgical Research, Germany.
Subjects:
12 male Sprague-Dawley rats
Interventions:
6 rats acted as controls, and 6 had brain death induced by inflation of an intracranial balloon.
Main Outcome Measures:
Mean arterial pressure, serum concentration of antidiuretic hormone (ADH), thyroxine (T4), free-T4, triiodothyronine (T3) and free-T3, bile production, intravital fluorescence microscopy and electron microscopic appearances.
Results:
After induction of brain death mean arterial pressure rose within 5 minutes followed by significant hypotension (p < 0.01). ADH concentration was reduced (p < 0.01), as was bile production (p < 0.05). There was impaired sinusoidal perfusion and increased interaction between leucocytes and endothelium in the hepatic microvasculature. The electron microscopic analysis showed vacuolisation of hepatocytes.
Conclusion:
Macrohaemodynamics, ADH homeostasis, and the hepatic microcirculation deteriorate after brain death, which leads to histomorphological damage of hepatocytes and compromised liver function.