The Impact of l-Thyroxine Treatment of Donors and Recipients on Postoperative Outcomes After Heart Transplantation

Holndonner–Kirst, Eniko; Nagy, Ádám; Czobor, Nikoletta Ráhel; Fazekas, Levente; Dohán, Orsolya; Kertai, Miklós D.; Lex, Dániel J.; Sax, Balázs; Hartyánszky, István; Merkely, Béla; Gál, János; Székely, Andrea

doi:10.1053/j.jvca.2018.10.024

Cited by 12 publications

(8 citation statements)

References 39 publications

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“…Weaning of norepinephrine was more frequent in the 80 BD donors who received steroids than the 128 ones who did not, although no benefit was observed in primary functional recovery of transplanted grafts[ 69 ]. Recipients of donor livers who had received steroids showed less ischemia-reperfusion injury and acute rejection[ 70 ]. Low-dose of steroids is preferred since high dose did not show differences in number of retrieved and transplanted organs[ 52 , 71 - 73 ].…”

Section: Vasoactive Drugsmentioning

confidence: 99%

Hemodynamic management in brain dead donors

Lazzeri¹,

Bonizzoli²,

Guetti³

et al. 2021

WJT

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Donor management is the key in the complex donation process, since up to 20% of organs of brain death donors (DBD) are lost due to hemodynamic instability. This challenge is made more difficult due to the lack of strong recommendations on therapies for hemodynamic management in DBDs and more importantly to the epidemiologic changes in these donors who are becoming older and with more comorbidities (marginal donors). In the present manuscript we aimed at summarizing the available evidence on therapeutic strategies for hemodynamic management (focusing on vasoactive drugs) and monitoring (therapeutic goals). Evidence on management in elderly DBDs is also summarized. Donor management continues critical care but with different and specific therapeutic goals since the number of donor goals met is related to the number of organs retrieved and transplanted. Careful monitoring of selected parameters (possibly including serial echocardiography) is the clinical tool able to guarantee the achievement and maintaining of therapeutic goals. Despide worldwide differences, norepinephrine is the vasoactive of choice in most countries but, whenever higher doses (> 0.2 mcg/kg/min) are needed, a second vasoactive drug (vasopressin) is advisable. Hormonal therapy (desmopressin, corticosteroid and thyroid hormone) are suggested in all DBDs independently of hemodynamic instability. In the single patient, therapeutic regimen (imprimis vasoactive drugs) should be chosen also according to the potential organs retrievable ( i.e. heart vs liver and kidneys).

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Section: Vasoactive Drugsmentioning

confidence: 99%

Hemodynamic management in brain dead donors

Lazzeri¹,

Bonizzoli²,

Guetti³

et al. 2021

WJT

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“…For instance, donor administration of L-T4 improved survival of the graft recipient. The recipients who received L-T4 prior to the transplantation had a survival advantage over those who did not and results were better when L-T4 was applied to the donor before the declaration of brain death ( 136 ). Early L-T4 therapy was associated with an increase in solid organ procurement rate with odds ratio of 1.9 ( 137 ).…”

Section: Medical Uses Of Iodothyronines Thyroamines and Iodoacetatesmentioning

confidence: 99%

Physiological Role and Use of Thyroid Hormone Metabolites - Potential Utility in COVID-19 Patients

Frőhlich

Wahl

2021

Front. Endocrinol.

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Thyroxine and triiodothyronine (T3) are classical thyroid hormones and with relatively well-understood actions. In contrast, the physiological role of thyroid hormone metabolites, also circulating in the blood, is less well characterized. These molecules, namely, reverse triiodothyronine, 3,5-diiodothyronine, 3-iodothyronamine, tetraiodoacetic acid and triiodoacetic acid, mediate both agonistic (thyromimetic) and antagonistic actions additional to the effects of the classical thyroid hormones. Here, we provide an overview of the main factors influencing thyroid hormone action, and then go on to describe the main effects of the metabolites and their potential use in medicine. One section addresses thyroid hormone levels in corona virus disease 19 (COVID-19). It appears that i) the more potently-acting molecules T3 and triiodoacetic acid have shorter half-lives than the less potent antagonists 3-iodothyronamine and tetraiodoacetic acid; ii) reverse T3 and 3,5-diiodothyronine may serve as indicators for metabolic dysregulation and disease, and iii) Nanotetrac may be a promising candidate for treating cancer, and resmetirom and VK2809 for steatohepatitis. Further, the use of L-T3 in the treatment of severely ill COVID-19 patients is critically discussed.

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“…42 −44 Similarly, in a retrospective study, pre-operative recipient or donor T3 substitution was associated with improved survival after HTx. 15 Indeed, pioneering single-center studies advocated the use of TH supplementation to both donor and recipient. 12 −14 The rationale for this recommendation was that by correcting the metabolic derangements that take place in the donor, the heart would be excised with high levels of energy stores, some of which would be utilized during periods of myocardial ischemia during transportation and transplantation.…”

Section: Recipient Th Replacementmentioning

confidence: 99%

Donor thyroid hormone therapy and heart transplantation outcomes: ISHLT transplant registry analysis

Peled

Ram

Klempfner

et al. 2020

The Journal of Heart and Lung Transplantation

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BACKGROUND: Donor thyroid hormone (TH) supplementation therapy is widely used. Recent reports suggested an increased risk of graft dysfunction in heart transplant (HTx) recipients not receiving TH supplementation. Our aim was to determine the effect of a donor TH supplementation in a large contemporary HTx cohort. METHODS: We analyzed data reported to the International Society for Heart and Lung Transplantation Registry on adult HTx recipients transplanted from 2006 to 2016. Early graft loss (EGL) was defined as death or retransplant because of graft failure within 48 hours of transplant. Logistic regression and propensity score analyses were performed. RESULTS: There were 23,002 adult HTx recipients transplanted during the study period for whom data on the use of donor TH supplementation were provided to the Registry. There were 15,821 recipients whose donors had received TH supplementation, and 7,181 who had not. Multivariable analysis showed donor TH therapy to be associated with an increased risk for EGL (odds ratio, 1.51; 95% CI, 1.13−2.06; p < 0.001). Long-term survival was similar, irrespective of donor TH supplementation. Recipients whose donors had received TH supplementation exhibited a lower 8-year incidence of vasculopathy (hazard ratio, 0.90; 95% CI, 0.85−0.97; p = 0.003). These results remained consistent in a propensity-matched analysis. CONCLUSIONS: Donor TH therapy is independently associated with an increased risk of EGL. Whether this is a result of the donor allograft intrinsic characteristics related to the reasons why TH was used or whether this is a result of a TH withdrawal effect, which could be mitigated by administration of TH to the recipient, should be further studied.

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The Impact of l-Thyroxine Treatment of Donors and Recipients on Postoperative Outcomes After Heart Transplantation

Cited by 12 publications

References 39 publications

Hemodynamic management in brain dead donors

Hemodynamic management in brain dead donors

Physiological Role and Use of Thyroid Hormone Metabolites - Potential Utility in COVID-19 Patients

Donor thyroid hormone therapy and heart transplantation outcomes: ISHLT transplant registry analysis

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