THE ENDOCRINE PANCREAS IN BRAIN-DEAD DONORS - A PROSPECTIVE-STUDY IN 25 PATIENTS

To determine whether hyperglycemia in brain-dead donors is a sign of e ndocrine pancreas insufficiency, we studied pancreatic function in 25 consecutive brain dead patients. Blood samples were drawn at 2-hr inte rvals from donor referral until organ procurement to analyze glucose, insulin, and C-peptide levels. After donor retrieval, two specimens we re taken from the pancreas for a subsequent immunohistochemical examin ation. At referral mean glycemia was 13.60+/-1.49 mmol/L, and there wa s a large range of plasma glucose levels (4.631. 6). Of 25 patients, 1 6 had glycemia above 10 mmol/L. At organ procurement a mean of 20 hr l ater, mean glycemia as 8.61+/-0.58 mmol/L (P<0.005 with paired t test) , and only 5 patients had glycemia above 10 mmol/L. Hyperglycemia was associated with elevated insulin and C-peptide levels during donor man agement. An elevated C-peptide/glucose molar ratio might be considered a sign of peripheral insulin resistance. Hyperglycemia above 25 mmol/ L could not be related to the amount of glucose administered during do nor maintenance. Severe hyperglycemia had a natural tendency to be par tly corrected. Histologic and immunohistochemical examinations were av ailable in 17 cases and can be considered normal. It is concluded that endocrine pancreatic function can be considered effective after brain death. The mechanism of the relative insulin resistance of these pati ents requires further study. Blood glucose levels, in the range observ ed in this study, are not a good donor criterion of endocrine pancreat ic function before pancreas transplantation.