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Exp Clin Endocrinol Diabetes 2016; 124(05): 318-323
DOI: 10.1055/s-0042-101240
Article
© Georg Thieme Verlag KG Stuttgart · New York

Effect of Insulin Therapy using Hyper-insulinemic Normoglycemic Clamp on Inflammatory Response in Brain Dead Organ Donors

M. Aljiffry   *
1   Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
,
M. Hassanain   *
2   Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
6   Department of Oncology, McGill University, Montreal, Canada
,
T. Schricker
4   Department of Anesthesia, McGill University Health Centre, Montreal, Canada
,
M. Shaheen
3   Department of Surgery, McGill University Health Centre, Montreal, Canada
,
T. Nouh
2   Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
R. Lattermann
4   Department of Anesthesia, McGill University Health Centre, Montreal, Canada
,
A. Salman
3   Department of Surgery, McGill University Health Centre, Montreal, Canada
,
L. Wykes
5   School of Dietetic and Human Nutrition, McGill University, Montreal, Canada
,
P. Metrakos
3   Department of Surgery, McGill University Health Centre, Montreal, Canada
› Author Affiliations
Further Information

Publication History

received 30 June 2015
first decision 17 December 2015

accepted 20 January 2016

Publication Date:
06 April 2016 (online)

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Abstract

Background: Brain death is a major stress that is associated with a massive inflammatory response and systemic hyperglycemia. Severe inflammation leads to increased graft immunogenicity and risk of graft dysfunction; while acute hyperglycemia aggravates the inflammatory response and increases the risk of morbidity and mortality. Insulin therapy not only controls hyperglycemia but also suppresses inflammation. The present study is to investigate the anti-inflammatory properties and the normoglycemia maintenance of high dose insulin on brain dead organ donors.

Design: 15 brain dead organ donors were divided into 2 groups, insulin treated (n=6) and controls (n=9). Insulin was provided for a minimum of 6 h using the hyperinsulinemic normoglycemic clamp technique. The changes of serum cytokines, including IL-6, IL-10, IL-1β, IL-8, TNFα, TGFα and MCP-1, were measured by suspension bead array immunoassay and glucose by a glucose monitor.

Results: Compared to controls, insulin treated donors had a significant lower blood glucose 4.8 (4–6.9) vs. 9 (5.6–11.7) mmol/L, p<0.01); the net decreases of pro-inflammatory cytokines, such as IL-6 and MCP-1, and the net increase of anti-inflammatory cytokine, such as IL-10, reached significant level in insulin treated donors compared with those in controls.

Conclusion: High dose insulin therapy decreases the concentrations of inflammatory cytokines in brain dead donors and preserves normoglycemia. High dose of insulin may have anti-inflammatory effects in brain dead organ donors and therefore, improve the quality of donor organs and potentially improve outcomes.

Key words

hormones - adipocytokines - transplantation - brain dead donors - inflammation

* Contributed equally as first authors


Supplementary Material

 

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