S-Nitrolysation (SNO) is a Useful Predictor of Successful Organ and VCA Procurement and a Novel Therapeutic Target to Increase the Number of Viable Transplants in Brain Dead Donors
Mohamed Awad, MD1, Cristin Coquillard, MD2, Kelsey Isbester1, Arvin Smith1, Samuel Boas1, Anil Manzanares1, Anand Kumar, MD1, James Reynolds, PhD1.
1Case Western Reserve University, Cleveland, OH, USA, 2Case Western Reserve University, cleveland, OH, USA.
Background: S-nitrosothiols (SNOs) are components found in blood that regulate a wide range of activities including blood flow, oxygen delivery, responses to disease or pollution, muscle performance, and metabolism. Our laboratory has demonstrated that brain death is associated with a decrease in SNO leading to a decrease in tissue micro perfusion. We hypothesized that SNO levels directly correlate with donor tissue/organ viability.
Methods: In a prospective cohort study of brain dead donors (n=63), serial measurements of S-nitrosohemoglobin (SNO-Hb) were collected and tissue oxygenation were monitored by tissue oxygen monitor (TStat). SNO levels were then correlated to microcirculation, organs failure rate, and lactate levels. Data analysis was done using R statistical software.
Results: SNOHb levels decrease immediately after brain death. Higher SNO-HB levels were inversely correlated with lactate levels (p<00.1) (R=0.61) and positive correlated with tissue oxygenation (p<00.1). Regression analysis identified SNO-Hb level as a strong primary predictor variable of whether recovered organs were deemed viable and as a direct predictor of quality of donor tissue (P=0.015) (R=0.4).
Conclusion: Our study demonstrated SNO-HB levels after brain death directly correlates with tissue perfusion and organ viability. Therapies to increase SNO-HB after brain death in the donor is a possible therapeutic target to improve microcirculation and the number of organs/VCA available for transplant.
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