Dopamine in transplantation: Written off or comeback with novel indication?

Abstract

Renal-dose dopamine has fallen out of favor in the intensive care unit (ICU) during past years due to its ineffectiveness to prevent impending or to ameliorate overt renal failure in the critically ill. By contrast, growing evidence indicates that low-dose dopamine administered to the stable organ donor after brain death confirmation improves the clinical course of transplanted organs after kidney and heart transplantation. Ensuring a thorough monitoring for potential circulatory side effects, employment of dopamine at a dose of 4 μg/kg/min is safe in the deceased donor. Among recipients, the advantageous effect is easy to achieve, inexpensive, and devoid of adverse side effects. The mode of action relies on dopamine's propensity to mitigate injury in various cell systems from isolated transplantable organs under cold storage conditions. The present review article summarizes the clinical evidence of dopamine donor pretreatment in solid organ transplantation and focuses on the underlying molecular mechanisms of cellular protection. Introducing the routine use of low-dose dopamine for the management of the brain-dead donor in the ICU before procurement provides an evidence-based strategy to improve graft outcome after kidney transplantation without conferring harm to non-renal grafts, namely to livers and hearts, in cases of multi-organ donation.

Donor Dopamine Does Not Affect Liver Graft Survival: Evidence of Safety From a Randomized Controlled Trial

“…In conclusion, this study demonstrates that the use of low‐dose dopamine at 4 µg/kg/minute in hemodynamically stable donors is safe in LT, and therefore, its use as a standard of care is warranted because it benefits other organs, kidneys, and hearts, without deleterious effects in liver allografts.…”

Donor organ intervention before kidney transplantation: Head-to-head comparison of therapeutic hypothermia, machine perfusion, and donor dopamine pretreatment. What is the evidence?

“…Interestingly, and supporting a notion that CIT length may influence the efficacy of MP, the MP trial investigators found in a recent post hoc analysis that the effect on DGF was largest for kidneys exposed to CIT <10 hours. [30][31][32][33] Dopamine's effectiveness requires diffusion into cells, 34 which under the steadystate conditions of continuous infusion is a time-dependent process. One also needs to bear in mind that any donor organ treatment administered before organ procurement will affect the outcome of two kidneys.…”

“…The molecular mechanisms conferring kidney protection by dopamine are not related to circulatory effects but rather depend on dopamine's antioxidant properties. [30][31][32][33] Dopamine's effectiveness requires diffusion into cells, 34 which under the steadystate conditions of continuous infusion is a time-dependent process.…”

Beyin Ölümü Tanısı Alan Hastaların Retrospektif Analizi

“…12,13 Donörde yeterli sıvı replasmanına rağmen hipotansiyon devam ediyorsa vazopressör olarak ilk planda düşük doz dopamin infüzyonu önerilmektedir. [12][13][14] Dopamine alternatif olarak veya ek vazopressör ihtiyacı mevcutsa vazopressin ve noradrenalin kullanılabilir. 13,15 Düşük doz dopamin infüzyonunun (4 µg/kg/dk) beyin ölümü deklarasyonundan hemen sonra başlanması gerektiği ve donörlerde güvenlice uygulanabileceği tavsiye edilmiştir.…”

“…Donöre uygulanan düşük doz dopamin infüzyonunun (4 µg/kg/dk) süresi (kros klemp konuncaya kadar) 7 saat ve üzerinde olduğunda organ transplantasyonundan sonra nakledilen organların klinik seyirlerini iyileştirdiği bildirilmiştir. 14,16,17 Donöre uygulanan düşük doz dopamin infüzyonunun böbrek transplantasyonundan sonra diyaliz ihtiyacını azalttığı, 14,18 kalp transplantasyonlarında da hastanın kliniğini iyileştirdiği gösterilmiştir. 17,19 Bu bilgiler ışığında hastanemizde donör bakımında standart olarak tüm donörlere 4 µg/kg/dk dopamin infüzyonu, metilprednizolon infüzyonu ve levotiroksin uygulanmıştır.…”