Estudo do perfil clínico e imunológico dos possíveis e potenciais doadores de órgãos no Hospital de Pronto Socorro João XXIII.

Abstract

This dissertation, composed of two articles, studies the clinical, epidemiologic and immune organ donor profile inpatient of Hospital João XXIII. The first article, we studied, 120 consecutive possible and potential brain-dead organ donors, clinical an epidemiologic profile, between July, 2007 and June, 2008, evaluated gender, age, diagnosis of coma, brain-dead confirmation, time stay in hospital, cardiac arrest, vasoactives agents and doses, blood pressure, cardiac frequency, temperature,complications, laboratory profile, infectious diseases blood tests to Chagas disease, hepatitis, toxoplamosis, syphilis, AIDS, cytomegalovirus, and HTLV-I e II, and transplantation. So observed 74.16% was male, mean age was 34.92 years, and the most frequent diagnosis to the brain-dead was brain injury (80%). The second articleanalyzes correlations between clinical profile and cytokines doses (pg/ml). We measure IL-1ß, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12; IL-10, TNF, e IFN GAMMA in Cytometric Bead Array. We evaluated 40 consecutive potential brain-dead organ donors (mean age 31,92 years, 72,5% males). We measured immediately criteria for brain death (or confirmatory tests) and after obtaining consent from families. Cytokines were assessed by cytometric bead array in the plasma and the alllaboratory personnel were blinded to clinical information. The main cause of brain death was cerebral trauma (95%) and stroke. The use of vasoactive agents was 95%. The median time stay in ICU was 2,65 ± 1,57 days and the 77,5% of patients were effective donors. Data (mean pg/ml) of cytokines were IL-2 3.32, IL-4 2.63, IL-5 11.4, IL-10 25.99, INF 9.72 and TNF 2.32. In 35% of donors IL-6 was above 5000 pg/ml. We did not find correlations (nonparametric statistical tests) between cytokinesand gender, age, laboratory tests our organs donors. Pearson correlation between IL-6 and TNF was 0.001. IL-2 and IL-10TH2 was 0.002 and IL-2 and INFG were 0.005. We concluded, in this way, that the brain death confirmation was possible in 54.16% of this patients represent lower hemodynamic instability, without correlation to gender and age, resulting in organ donor 36.66% of these patients; and the levels pro and anti-inflammatory cytokines were increased in brain-dead donors and were correlated. There was no difference among cytokines and clinical and laboratory profiles.