Effects of Donor Pretreatment With Dopamine on Graft Function After Kidney Transplantation

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 lowdose dopamine improves early graft function in human renal transplant recipients. Design, Setting, and Patients Randomized, open-label, multicenter, parallelgroup 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 µg/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; PϽ.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; PϽ.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.

Comments on “Impact of spontaneous donor hypothermia on graft outcomes after kidney transplantation”

“…Using a retrospective cohort that was part of a donor intervention trial published in 2009, 1 Schnuelle et al report in this issue that spontaneous hypothermia in deceased organ donors resulted in decreased recipient renal delayed graft function. 2 Allograft survival was not statistically significantly different during long-term follow-up.…”

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

“…However, these recommendations remain inadequately supported in the literature, because of limited clinical data from controlled trials, on graft outcome (6,7). We recently presented a randomized, controlled clinical trial that showed that pre-treatment of brain-dead donors with low-dose dopamine of 4 g/kg/min reduces the dialysis requirement after kidney transplantation (8). The underlying mechanism is related to antioxidant properties of the dopamine molecule (9).…”

Conséquences cardiovasculaires de la mort cérébrale et prise en charge pour prélèvement d’organe(s)

“…La dopamine est susceptible d'entraîner la survenue plus fréquente de troubles du rythme cardiaque [63]. Schnuelle et al ont montré dans une étude randomisée ouverte que l'administration de dopamine à faible posologie (4 µg/kg/min), en plus d'une prise en charge classique, permettait une diminution significative du recours à la dialyse dans la première semaine suivant la greffe [64]. Cependant, ce travail présentait plusieurs biais : il s'agissait d'une étude ouverte, les motifs de réalisation d'une dialyse n'étaient pas prédéfinis, ni standardisés et l'objectif principal de l'étude n'était pas cliniquement relevant.…”