Effects of Donor Pre-Treatment With Dopamine on Survival After Heart Transplantation

Benck, Urs; Hoeger, Simone; Brinkkoetter, Paul T.; Göttmann, Uwe; Doenmez, D.; Boesebeck, Detlef; Lauchart, W.; Gummert, Jan; Kretzler, Matthias; Lehmkuhl, H.; Bittner, Hartmuth B.; Zuckermann, Andreas; Wagner, Florian; Schulz, Uwe; Koch, Achim; Bigdeli, Amir K.; Bara, Christoph; Hirt, Stephan; Berchtold‐Herz, Michael; Brose, Stefan; Herold, Ulf; Boehm, Johannes; Welp, Henryk; Strecker, Thomas; Doesch, Andreas O.; Birck, Rainer; Krämer, Bernhard K.; Yard, Benito A.; Schnuelle, Peter

doi:10.1016/j.jacc.2011.05.060

Cited by 70 publications

(18 citation statements)

References 32 publications

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“…This would not negate the association seen in this study, but rather offer a different understand of why it is. However, in preliminary analysis, no obvious donor factors seemed to play a role in the decision to administer dopamine, and as literature supporting the use of donor dopamine is quite recent, it is unlikely that this played a factor either 5,6 . Of note, we did not notice any time dependent effect in the proportion of donors receiving dopamine with similar rates of use occurring throughout the study period (unpublished data).…”

Section: Discussionmentioning

confidence: 94%

“…While the association of right heart failure and high recipient pulmonary vascular resistance is well described, the importance of donor factors prior to procurement is becoming increasingly clear 2–4,7–9 . The use of low-dose dopamine in donors prior to organ procurement has been shown to improve kidney graft outcomes, and may be linked to improved long-term outcomes in adult heart recipients 5,6 . The present study showed an association between the use of low-dose dopamine in donors and a decrease in the incidence of early postoperative right heart failure in pediatric heart recipients as well as benefits in duration of mechanical ventilation and hospital length of stay.…”

Section: Discussionmentioning

confidence: 99%

“…The use of inotropic support in potential cardiac donors, including dopamine, is usually considered a negative indicator of donor quality. However, low-dose dopamine pretreatment of brain-dead donors has recently been associated with improved long-term survival in adult cardiac transplant recipients 6 . Nevertheless, the possible peri-operative benefits of donor dopamine in pediatric cardiac transplant recipients have yet to be examined.…”

Section: Introductionmentioning

confidence: 99%

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Low-Dose Donor Dopamine Is Associated With a Decreased Risk of Right Heart Failure in Pediatric Heart Transplant Recipients

et al. 2016

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Background Previous studies in adults have suggested that donor dopamine treatment may improve recipient outcomes in organ transplantation; in this analysis, we aimed to determine if donor dopamine reduces the incidence of post-operative right heart failure in pediatric heart transplant recipients. Methods Data for recipients aged ≤ 18 transplanted at our institution between 1/1/2000–6/15/2011 and their respective donors were obtained. The presence of postoperative right heart failure was assessed for in all subjects. Donor dopamine dose was stratified into 3 groups: none, low-dose (≤ 5 mcg/kg/min), and high-dose (>5 mcg/kg/min). Logistic regression was used to assess the relationship between donor dopamine dose and recipient right heart failure. Results Of 192 recipients, 34 (18%) experienced postoperative right heart failure. There was no difference in baseline demographics between recipients with and without right heart failure. When controlling for pulmonary vascular resistance index, graft ischemic time, and cardiopulmonary bypass time, donor low-dose dopamine was independently associated with a decreased risk of right heart failure (OR=0.16 [0.04–0.70]; p=0.02); however high-dose DA was neither associated with, nor protective of, RHF (OR: 0.31 [0.06–1.6]; p=0.16). Conclusions Despite advances in perioperative care of the recipient, right heart failure persists as a complication of pediatric heart transplantation. In this study donor pre-treatment with low-dose dopamine is associated with a decreased risk of postoperative right heart failure in pediatric heart recipients. Further studies into this association may be useful in determining the utility of empiric donor pre-treatment with low-dose dopamine.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Low-Dose Donor Dopamine Is Associated With a Decreased Risk of Right Heart Failure in Pediatric Heart Transplant Recipients

et al. 2016

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“…Second, we chose to maintain a constant PaCO 2 by decreasing the respiratory rate in the high V T group rather than adding instrumental dead space. Third, we did not use catecholamines but a rather liberal fluid management to prevent hypotension and avoid possible interaction in modulating inflammatory response, organ function and gene expression [18,45-47]. Fourth, we did not assess whether the LV T /OLPEEP strategy can protect other organs except the lung from the pro-inflammatory effects of massive brain damage.…”

Section: Discussionmentioning

confidence: 99%

Open lung approach with low tidal volume mechanical ventilation attenuates lung injury in rats with massive brain damage

et al. 2014

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IntroductionThe ideal ventilation strategy for patients with massive brain damage requires better elucidation. We hypothesized that in the presence of massive brain injury, a ventilation strategy using low (6 milliliters per kilogram ideal body weight) tidal volume (VT) ventilation with open lung positive end-expiratory pressure (LVT/OLPEEP) set according to the minimal static elastance of the respiratory system, attenuates the impact of massive brain damage on gas-exchange, respiratory mechanics, lung histology and whole genome alterations compared with high (12 milliliters per kilogram ideal body weight) VT and low positive end-expiratory pressure ventilation (HVT/LPEEP).MethodsIn total, 28 adult male Wistar rats were randomly assigned to one of four groups: 1) no brain damage (NBD) with LVT/OLPEEP; 2) NBD with HVT/LPEEP; 3) brain damage (BD) with LVT/OLPEEP; and 4) BD with HVT/LPEEP. All animals were mechanically ventilated for six hours. Brain damage was induced by an inflated balloon catheter into the epidural space. Hemodynamics was recorded and blood gas analysis was performed hourly. At the end of the experiment, respiratory system mechanics and lung histology were analyzed. Genome wide gene expression profiling and subsequent confirmatory quantitative polymerase chain reaction (qPCR) for selected genes were performed.ResultsIn NBD, both LVT/OLPEEP and HVT/LPEEP did not affect arterial blood gases, as well as whole genome expression changes and real-time qPCR. In BD, LVT/OLPEEP, compared to HVT/LPEEP, improved oxygenation, reduced lung damage according to histology, genome analysis and real-time qPCR with decreased interleukin 6 (IL-6), cytokine-induced neutrophil chemoattractant 1 (CINC)-1 and angiopoietin-4 expressions. LVT/OLPEEP compared to HVT/LPEEP improved overall survival.ConclusionsIn BD, LVT/OLPEEP minimizes lung morpho-functional changes and inflammation compared to HVT/LPEEP.

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“…Reasons for refusal may include donor cause of death (4, 6), history of cardiac arrest and/or CPR (7), vasopressors or inotropes at the time of procurement (8, 9), thoracic trauma, anticipated graft ischemic time (9), donor troponin levels (9-11), abnormal EKG findings (4,12), donor sepsis, or abnormal echocardiogram (4). …”

Section: Discussionmentioning

confidence: 99%

Pediatric Cardiac Transplantation Using Hearts Previously Refused for Quality: A Single Center Experience

Easterwood

Singh

McFeely

et al. 2013

American Journal of Transplantation

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Pediatric donor hearts are regularly refused for donor quality with limited evidence as to which donor parameters are predictive of poor outcomes. We compare outcomes of recipients receiving hearts previously refused by other institutions for quality with the outcomes of recipients of primarily-offered hearts. Data for recipients aged ≤ 18 and their donors were obtained. Specific UNOS refusal codes were used to place recipients into refusal and non-refusal groups; demographics, morbidity, and mortality were compared. Kaplan-Meier analysis with log-rank test was used to determine differences in graft survival. A multivariable Cox proportional hazards model was constructed to determine independent risk factors for post-operative mortality. From 7/1/2000-4/30/2011, 182 recipients were transplanted and included for analysis. 130 received a primarily-offered heart; 52 received a refused heart. No difference in post-operative complications or graft survival between the two groups (p=0.355) was found. Prior refusal was not an independent risk factor for recipient mortality. Analysis of this large pediatric cohort examining outcomes with quality-refused hearts shows that in-hospital morbidity and long-term mortality for recipients of quality-refused hearts is no different than recipients of primarily-offered hearts, suggesting that donor hearts previously refused for quality are not necessarily unsuitable for transplant and often show excellent outcomes.

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Effects of Donor Pre-Treatment With Dopamine on Survival After Heart Transplantation

Cited by 70 publications

References 32 publications

Low-Dose Donor Dopamine Is Associated With a Decreased Risk of Right Heart Failure in Pediatric Heart Transplant Recipients

Low-Dose Donor Dopamine Is Associated With a Decreased Risk of Right Heart Failure in Pediatric Heart Transplant Recipients

Open lung approach with low tidal volume mechanical ventilation attenuates lung injury in rats with massive brain damage

Pediatric Cardiac Transplantation Using Hearts Previously Refused for Quality: A Single Center Experience

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