Intérêt de l'hormonothérapie associant triiodothyronine et cortisone chez le patient en état de mort cérébrale

Mariot, J.; Jacob, F.; Voltz, C.; Perrier, Jean‐François; Strub, P.

doi:10.1016/s0750-7658(05)80806-8

Cited by 29 publications

(5 citation statements)

References 18 publications

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“…A single intravenous dose of methylprednisolone was the most common regimen, ranging in dose from 1 gm to 5 gm. Three trials tested corticosteroid therapy in isolation 26 29 30 ; two others evaluated corticosteroids in a factorial design with liothyronine, 28 35 one as part of combined hormonal therapy with liothyronine 27 and five placebo-controlled trials administered corticosteroids in combination with cyclophosphamide. 25 31–34 The timing of corticosteroid therapy also varied across studies.…”

Section: Resultsmentioning

confidence: 99%

“…25 31–34 The timing of corticosteroid therapy also varied across studies. Corticosteroids were administered 30 to 60 min after death declaration in one study, 27 immediately after consent for organ donation in three studies 28 29 35 and 3 to 8 hours before surgery in seven studies. 25 26 30–34 In most studies, methylprednisolone was dosed every 24 hours.…”

Section: Resultsmentioning

confidence: 99%

“…Indirectness of evidence was another important reason for rating down the overall quality of evidence. Six studies combining all steroid interventions (but not control interventions) with other hormone therapies, 27 34 or with cyclophosphamide, 30–33 provide only indirect evidence of the potential treatment effects of corticosteroids alone. Variation in timing of randomisation and subsequent administration of study intervention also have affected treatment effect presuming that later administration (ie, 5–8 hours before organ recovery) may be less effective.…”

Section: Discussionmentioning

confidence: 99%

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Effect of corticosteroid administration on neurologically deceased organ donors and transplant recipients: a systematic review and meta-analysis

et al. 2017

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ObjectivesThis review investigates the impact of corticosteroids on donation rates and transplant outcomes in light of findings from randomised controlled trials (RCTs) and to highlight the sources of uncertainty in this unresolved donor management issue.Data sourcesWe searched electronic databases, trial registries and conference proceedings for RCTs evaluating corticosteroid therapy in neurologically deceased donors.Study selection and data extractionIndependent reviewers assessed eligibility, evaluated risk of bias and abstracted data, including donor haemodynamic data, number of organs recovered and transplant outcomes. Where possible, we pooled results. For each outcome, we assessed the overall quality of evidence using The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.Data synthesisEleven RCTs with different corticosteroid regimens were included. Most trials assessed a once-daily infusion of methylprednisolone. Aside from one study showing improved liver graft function, no individual study or pooled analysis showed benefit of corticosteroids for any outcome: vasopressor use (three trials; relative risk (RR) 0.96; 95% CI 0.89 to 1.05), multiple organs recovered (two trials; RR 0.82; 95% CI 0.61 to 1.11), acute graft rejection (three trials; RR 0.91; 95% CI 0.60 to 1.39) or graft dysfunction (eight trials; RR 1.01; 95% CI 0.83 to 1.24). Two trials investigated adverse effects and found similar rates between groups. Quality of evidence was moderate or low for all outcomes.ConclusionCurrent clinical trials are limited in numbers and size to identify benefits or harms of corticosteroid therapy for deceased organ donors. In the face of these results, administering or withholding steroids both appear reasonable courses of action.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effect of corticosteroid administration on neurologically deceased organ donors and transplant recipients: a systematic review and meta-analysis

et al. 2017

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“…Investigators for studies with outstanding results or minimal information available were contacted, and studies only included if a response with further information was received. One French study was kindly translated by a native speaker to allow inclusion (9). No other studies published in other languages were identi ed.…”

Section: Eligibility and Study Selectionmentioning

confidence: 99%

“…The COVID-19 pandemic offered a rst opportunity to study the role of steroids for one de ned pathology within the critical care population and the results of the RECOVERY trial con rmed a bene cial role for dexamethasone for patients requiring oxygen or respiratory support (45)(46)(47). Both biological sex as well as ethnicity (amongst other factors) are suggested to play a role in contributing to the shape of the in ammatory response during severe illness (9). The contribution of such donor factors to their in ammatory response and how it could be shaped by treatments, is therefore an important factor to consider and ought to be routinely reported for the donor (and recipient) population in donor management studies.…”

Section: Key Ndingsmentioning

confidence: 99%

Outcome measures in solid organ donor management research: a systematic review

Bera

Shah

English

et al. 2021

British Journal of Anaesthesia

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BackgroundTo systematically review published outcome measures across randomised controlled trials (RCTs) of donor management interventions. MethodsThe systematic review was conducted in accordance with recommendations by the Cochrane Handbook and PRISMA statement. We searched MEDLINE, EMBASE, CENTRAL, Web of Science as well as trial databases from 1980 to December 2019 for RCTs of donor management interventions. ResultsTwenty-two RCTs (n = 3432 donors) were included in our analysis. Fourteen RCTs (63.6%) reported a primary outcome relating to a single organ only. Eight RCTs primarily focused on aspects of donor optimisation in critical care. Thyroid hormones and methylprednisolone were the most commonly evaluated interventions ( ve and four studies, respectively). Only two studies, focusing on single organs (e.g. kidney), evaluated outcomes relating to other organs. The majority of studies evaluated physiological or biomarker-related outcomes. No study evaluated recipient health-related quality of life.Only one study sought consent from potential organ recipients. ConclusionsThe majority of RCTs evaluating donor management interventions only assessed single organ outcomes or effects on donor stability in critical care. There is a need for an evaluation of patient-centred recipient outcomes, and standardisation and reporting of outcome measures for future donor management RCTs.

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Early Clinical Experience of Hormonal Therapy in the Brain-Dead Potential Organ Donor

Novitzky

Ekser

Cooper

2012

The Brain-Dead Organ Donor

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Intérêt de l'hormonothérapie associant triiodothyronine et cortisone chez le patient en état de mort cérébrale

Cited by 29 publications

References 18 publications

Effect of corticosteroid administration on neurologically deceased organ donors and transplant recipients: a systematic review and meta-analysis

Effect of corticosteroid administration on neurologically deceased organ donors and transplant recipients: a systematic review and meta-analysis

Outcome measures in solid organ donor management research: a systematic review

Early Clinical Experience of Hormonal Therapy in the Brain-Dead Potential Organ Donor

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