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Titel:

Effects of donor pretreatment with dopamine on graft function after kidney transplantation: a randomized controlled trial.

Dokumenttyp:
Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
Autor(en):
Schnuelle, P; Gottmann, U; Hoeger, S; Boesebeck, D; Lauchart, W; Weiss, C; Fischereder, M; Jauch, KW; Heemann, U; Zeier, M; Hugo, C; Pisarski, P; Krämer, BK; Lopau, K; Rahmel, A; Benck, U; Birck, R; Yard, BA
Abstract:
CONTEXT: Kidney graft function after transplantation can be improved through pharmacological donor pretreatment to limit organ injury from cold preservation. OBJECTIVE: To determine whether pretreatment of brain-dead donors with low-dose dopamine improves early graft function in human renal transplant recipients. DESIGN, SETTING, AND PATIENTS: Randomized, open-label, multicenter, parallel-group trial of 264 deceased heart-beating donors and 487 subsequent renal transplants performed at 60 European centers between March 2004 and August 2007 (final follow-up, December 31, 2008). Eligible donors were stable under low-dose norepinephrine with a normal serum creatinine concentration on admission. INTERVENTIONS: Donors were randomized to receive low-dose dopamine (4 mug/kg/min). MAIN OUTCOME MEASURES: Dialysis requirement during first week after transplantation. RESULTS: Dopamine was infused for a median of 344 minutes (IQR, 215 minutes). Dialysis was significantly reduced in recipients of a dopamine-treated graft. Fewer recipients in the treatment group needed multiple dialyses (56/227; 24.7%; 95% CI, 19.0%-30.3%; vs 92/260; 35.4%; 95% CI, 29.5%-41.2%; P = .01). The need for multiple dialyses posttransplant was associated with allograft failure after 3 years (HR, 3.61; 95% CI, 2.39-5.45; P < .001), whereas a single dialysis was not (HR, 0.67; 95% CI, 0.21-2.18; P = .51). Besides donor dopamine (OR, 0.54; 95% CI, 0.35-0.83; P = .005), cold ischemic time (OR, 1.07; 95% CI, 1.02-1.11 per hour; P = .001), donor age (OR, 1.03; 95% CI, 1.01-1.05 per year; P < .001), and recipient body weight (OR, 1.02; 95% CI, 1.01-1.04 per kg; P = .009) were independent explanatory variables in a multiple logistic regression model. Dopamine resulted in significant but clinically meaningless increases in the donor's systolic blood pressure (3.8 mm Hg; 95% CI, 0.7-6.9 mm Hg; P = .02) and urine production before surgical recovery of the kidneys (29 mL; 95% CI, 7-51 mL; P = .009) but had no influence on outcome. CONCLUSION: Donor pretreatment with low-dose dopamine reduces the need for dialysis after kidney transplantation. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00115115.
Zeitschriftentitel:
JAMA
Jahr:
2009
Band / Volume:
302
Heft / Issue:
10
Seitenangaben Beitrag:
1067-75
Sprache:
eng
Volltext / DOI:
doi:10.1001/jama.2009.1310
PubMed:
http://view.ncbi.nlm.nih.gov/pubmed/19738091
Print-ISSN:
0098-7484
TUM Einrichtung:
Fachgebiet Nephrologie (Prof. Heemann)
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