Administration of desmopressin in brain-dead donors and renal function in kidney recipients

Background Diabetes insipidus is common among brain-dead donors and may lead to decreased graft function. The use of desmopressin to limit the consequences of diabetes insipidus is controversial. We assessed the effects of desmopressin administered to brain-dead donors on early and long-term graft function in kidney recipients. Methods In a randomised controlled study, 97 brain-dead donors received desmopressin as 1 μg bolus every 2 h when diuresis was more than 300 mL/h (desmopressin group n=49) or no desmopressin (control group n=48). In 175 kidney recipients (controls n=89, desmopressin group n=86) we measured serum concentrations of creatinine and haemodialysis requirements to assess early renal function in the first 15 days after transplantation. We assessed longterm results of transplantation (median time 45 months) for a homogeneous subgroup of 95 recipients (48 in the desmopressin group). Findings We found no significant differences between the two groups of brain-dead donors, except for final diuresis, which was lower in the desmopressin group than among controls. Haemodialysis requirement in controls and the desmopressin group (20 vs 23%, p=0·63) and serum creatinine concentrations (decrease from 903 μmol/L to 206 μmol/L vs814 μmol/L to 193 μmol/L, p=0·14) did not differ significantly in the first 15 days after transplantation. Long-term graft survival was similar in the two groups (88 vs 87%). Interpretation Desmopressin can be given to brain-dead donors to limit the harmful effects of diabetes insipidus without any substantial effects to graft function in recipients.