High-dose catecholamine donor support and outcomes after heart transplantation

A single‐center long‐term experience with marginal donor utilization for heart transplantation

“…In our series, low D/R‐PHM ratio and ischemic time >4 hours were not predictive of mortality, while high‐dose inotropic support was an independent risk factor of mortality after HT only at univariate analysis. Previous reports showed association between donor norepinephrine use and PGD, 30 conversely a recent paper showed that in the presence of favorable recipient‐donor sex combinations and short ischemic times, donor norepinephrine dose is not associated with mortality and PGD 31 . Donor age is a well‐known risk factor of mortality after HT 32 especially when it is associated with a prolonged ischemic time 33 and our results confirmed that donor age >55 years is an independent risk factor of mortality at multivariate analysis.…”

Donor heart and lung procurement: A consensus statement

“…40 Higher doses of these agents (>0.2 mg/kg/min) have been reported to increase the risk of cardiac injury, 35,41,42 although in recent literature, the use of norepinephrine in the donor has been deemed safe. Angleitner et al 43 reported no significant differences in 30-day and 1-year mortality, primary graft dysfunction, and the need for renal replacement therapy after heart transplantation when heart donors who did not require vasopressors were compared against those who were on low-dose norepinephrine (0.01−0.1 mg/kg/min), or when those on low-dose norepinephrine (0.01−0.1 mg/kg/min) were compared with those on higher-dose norepinephrine (>0.1 mg/kg/min). 43 Recipients who received hearts from donors on norepinephrine had prolonged intensive care unit (ICU) length of stay.…”

“…Angleitner et al 43 reported no significant differences in 30-day and 1-year mortality, primary graft dysfunction, and the need for renal replacement therapy after heart transplantation when heart donors who did not require vasopressors were compared against those who were on low-dose norepinephrine (0.01−0.1 mg/kg/min), or when those on low-dose norepinephrine (0.01−0.1 mg/kg/min) were compared with those on higher-dose norepinephrine (>0.1 mg/kg/min). 43 Recipients who received hearts from donors on norepinephrine had prolonged intensive care unit (ICU) length of stay. 43 Hence, echocardiograms should be interpreted in the context of vasopressor(s) support that the donor was receiving at the time of the study and may need to be repeated.…”

“…43 Recipients who received hearts from donors on norepinephrine had prolonged intensive care unit (ICU) length of stay. 43 Hence, echocardiograms should be interpreted in the context of vasopressor(s) support that the donor was receiving at the time of the study and may need to be repeated.…”

Hurdles to Cardioprotection in the Critically Ill

“…Indeed, high inotrope dependence and significant myocardial dysfunction can prohibit organ donation (based on medical grounds) [340,341]. Due to the shortage of acceptable donor hearts, several studies have demonstrated that using these “extended criteria” donors on high inotrope support is an acceptable strategy for expanding the donor pool [342,343,344]. Conversely, left ventricular mechanical unloading (as occurs with VAD implantation, V-A-ECMO) increases β 1 -AR [345] and β 2 -AR mRNA expression (also tolerance to IRI) [346], and reduces GRK2 expression and activity [347,348], which may explain the improved β-AR responsiveness and total β-AR density observed post-VAD implantation [347,348,349].…”