Effects of donor pre-treatment with dopamine on survival after heart transplantation: a cohort study of heart transplant recipients nested in a randomized controlled multicenter trial.

Benck, U; Hoeger, S; Brinkkoetter, PT; Gottmann, U; Doenmez, D; Boesebeck, D; Lauchart, W; Gummert, J; Karck, M; Lehmkuhl, HB; Bittner, HB; Zuckermann, A; Wagner, F; Schulz, U; Koch, A; Bigdeli, AK; Bara, C; Hirt, S; Berchtold-Herz, M; Brose, S; Herold, U; Boehm, J; Welp, H; Strecker, T; Doesch, A; Birck, R; Krämer, BK; Yard, BA; Schnuelle, P

doi:10.1016/j.jacc.2011.05.060

journal article

Dokumenttyp:: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Article
Autor(en):: Benck, U; Hoeger, S; Brinkkoetter, PT; Gottmann, U; Doenmez, D; Boesebeck, D; Lauchart, W; Gummert, J; Karck, M; Lehmkuhl, HB; Bittner, HB; Zuckermann, A; Wagner, F; Schulz, U; Koch, A; Bigdeli, AK; Bara, C; Hirt, S; Berchtold-Herz, M; Brose, S; Herold, U; Boehm, J; Welp, H; Strecker, T; Doesch, A; Birck, R; Krämer, BK; Yard, BA; Schnuelle, P
Titel:: Effects of donor pre-treatment with dopamine on survival after heart transplantation: a cohort study of heart transplant recipients nested in a randomized controlled multicenter trial.
Abstract:: We determined the outcome of cardiac allografts from multiorgan donors enrolled in a randomized trial of donor pre-treatment with dopamine.Treatment of the brain-dead donor with low-dose dopamine improves immediate graft function after kidney transplantation.A cohort study of 93 heart transplants from 21 European centers was undertaken between March 2004 and August 2007. We assessed post-transplant left ventricular function (LVF), requirement of a left ventricular assist device (LVAD) or biventricular assist device (BVAD), need for hemofiltration, acute rejection, and survival of recipients of a dopamine-treated versus untreated graft.Donor dopamine was associated with improved survival 3 years after transplantation (87.0% vs. 67.8%, p = 0.03). Fewer recipients of a pre-treated graft required hemofiltration after transplant (21.7% vs. 40.4%, p = 0.05). Impaired LVF (15.2% vs. 21.3%, p = 0.59), requirement of a LVAD (4.4% vs. 10.6%, p = 0.44), and biopsy-proven acute rejection (19.6% vs. 14.9%, p = 0.59) were not statistically different between groups. Post-transplant impaired LVF (hazard ratio [HR]: 4.95; 95% confidence interval [CI]: 2.08 to 11.79; p < 0.001), requirement of LVAD (HR: 6.65; 95% CI: 2.40 to 18.45; p < 0.001), and hemofiltration (HR: 2.83; 95% CI: 1.20 to 6.69; p = 0.02) were predictive of death. The survival benefit remained (HR: 0.33; 95% CI: 0.12 to 0.89; p = 0.03) after adjustment for various risks affecting mortality, including pre-transplant LVAD/BVAD, inotropic support, and impaired kidney function.Treatment of brain-dead donors with dopamine of 4 ?g/kg/min will not harm cardiac allografts but appears to improve the clinical course of the heart allograft recipient. (Prospective Randomized Trial to Evaluate the Efficacy of Donor Preconditioning With Dopamine on Initial Graft Function After Kidney Transplantation; NCT00115115).
Zeitschriftentitel:: J Am Coll Cardiol
Jahr:: 2011
Band / Volume:: 58
Heft / Issue:: 17
Seitenangaben Beitrag:: 1768-77
Sprache:: eng
Volltext / DOI:: doi:10.1016/j.jacc.2011.05.060
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/21996389
Print-ISSN:: 0735-1097
TUM Einrichtung:: Klinik für Herz- und Gefäßchirurgie (Prof. Lange)
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