Low-Dose Donor Dopamine Is Associated With a Decreased Risk of Right Heart Failure in Pediatric Heart Transplant Recipients

Richmond, Marc E.; Easterwood, Rachel; Singh, Rakesh K.; Gilmore, Lisa; Beddows, Kimberly; Zuckerman, Warren A.; McFeely, Eric D.; Chen, Jonathan M.; Addonizio, Linda J.

doi:10.1097/tp.0000000000001059

Cited by 21 publications

(22 citation statements)

References 13 publications

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“…In addition, the trial intervention was associated with improved heart allograft survival 3 years after transplantation, which was 87.0% and 67.8%, respectively . A more recent retrospective study from New York in pediatric heart transplantation supported our findings and found that low‐dose donor dopamine was associated with a decreased risk of postoperative right heart failure, while the beneficial effect was offset at higher doses exceeding 5 μg/kg/min . Growing evidence from experimental studies indicates that dopamine or its derivative NOD is capable to preserve also cardiomyocytes from cold storage injury .…”

Section: Effect On the Performance Of Non‐renal Graftssupporting

confidence: 81%

“…That dopamine is a fully approved drug for some time now can be considered an advantage because dopamine’s spectrum of adverse effects is well known from its broad use in the intensive care medicine. In cases of multi‐organ donation, the risk for deterioration of non‐target organs, such as livers and hearts, post‐transplant is arguably low even when dosages ≥10 μg/kg/min were administered to the DBD . Particular data on the post‐transplant performance of pancreases, lungs, and small bowel according to donor employment of dopamine are scarce or even lacking.…”

Section: Summary and Perspectivementioning

confidence: 99%

“…45 A more recent retrospective study from New York in pediatric heart transplantation supported our findings and found that low-dose donor dopamine was associated with a decreased risk of postoperative right heart failure, while the beneficial effect was offset at higher doses exceeding 5 μg/kg/min. 46 Growing evidence from experimental studies indicates that dopamine or its derivative NOD is capable to preserve also cardiomyocytes from cold storage injury. 36,47,48 In addition, dopamine increased the tolerance of lungs to withstand tissue damage from hypothermic preservation in an isolated ventilation/perfusion model of the rat.…”

Section: Effec T On the Performan Ce Of Non -Renal G R Af Tsmentioning

confidence: 99%

“…In cases of multi-organ donation, the risk for deterioration of non-target organs, such as livers and hearts, post-transplant is arguably low even when dosages ≥10 μg/ kg/min were administered to the DBD. 23,45,46,[53][54][55] Particular data on the post-transplant performance of pancreases, lungs, and small bowel according to donor employment of dopamine are scarce or even lacking. One possible solution is to leave out donor dopamine preconditioning in instances when these organs are intended for transplantation.…”

Section: Safe T Y Of the Dopamine Infus I On In The Db Dmentioning

confidence: 99%

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

Schnuelle¹,

Benck

Yard

2018

Clinical Transplantation

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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.

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Section: Effect On the Performance Of Non‐renal Graftssupporting

confidence: 81%

Section: Summary and Perspectivementioning

confidence: 99%

Section: Effec T On the Performan Ce Of Non -Renal G R Af Tsmentioning

confidence: 99%

Section: Safe T Y Of the Dopamine Infus I On In The Db Dmentioning

confidence: 99%

See 2 more Smart Citations

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

Schnuelle¹,

Benck

Yard

2018

Clinical Transplantation

View full text Add to dashboard Cite

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“…In a randomized multicenter trial, the pretreatment of BDD with low-dose dopamine has been associated with an improved heart allograft recipients' clinical course after transplantation (6) and with a decreased risk of postoperative right heart failure in pediatric heart recipients (9). In a randomized multicenter trial, the pretreatment of BDD with low-dose dopamine has been associated with an improved heart allograft recipients' clinical course after transplantation (6) and with a decreased risk of postoperative right heart failure in pediatric heart recipients (9).…”

Section: Introductionmentioning

confidence: 99%

Donor Preconditioning After the Onset of Brain Death With Dopamine Derivate n-Octanoyl Dopamine Improves Early Posttransplant Graft Function in the Rat

Korkmaz‐Icöz

Radovits

et al. 2017

American Journal of Transplantation

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Heart transplantation is the therapy of choice for end-stage heart failure. However, hemodynamic instability, which has been demonstrated in brain-dead donors (BDD), could also affect the posttransplant graft function. We tested the hypothesis that treatment of the BDD with the dopamine derivate n-octanoyl-dopamine (NOD) improves donor cardiac and graft function after transplantation. Donor rats were given a continuous intravenous infusion of either NOD (0.882 mg/kg/h, BDD+NOD, n = 6) or a physiological saline vehicle (BDD, n = 9) for 5 h after the induction of brain death by inflation of a subdural balloon catheter. Controls were sham-operated (n = 9). In BDD, decreased left-ventricular contractility (ejection fraction; maximum rate of rise of left-ventricular pressure; preload recruitable stroke work), relaxation (maximum rate of fall of left-ventricular pressure; Tau), and increased end-diastolic stiffness were significantly improved after the NOD treatment. Following the transplantation, the NOD-treatment of BDD improved impaired systolic function and ventricular relaxation. Additionally, after transplantation increased interleukin-6, tumor necrosis factor TNF-α, NF-kappaB-p65, and nuclear factor (NF)-kappaB-p105 gene expression, and increased caspase-3, TNF-α and NF-kappaB protein expression could be significantly downregulated by the NOD treatment compared to BDD. BDD postconditioning with NOD through downregulation of the pro-apoptotic factor caspase-3, pro-inflammatory cytokines, and NF-kappaB may protect the heart against the myocardial injuries associated with brain death and ischemia/reperfusion.

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

et al. 2018

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Treatment of donation after brain death (DBD) donors with low-dose dopamine improves the outcomes after kidney and heart transplantation. This study investigates the course of liver allografts from multiorgan donors enrolled in the randomized dopamine trial between 2004 and 2007 (clinicaltrials.gov identifier: NCT00115115). There were 264 hemodynamically stable DBDs who were randomly assigned to receive low-dose dopamine. Dopamine was infused at 4 μg/kg/minute for a median duration of 6.0 hours (interquartile range, 4.4-7.5 hours). We assessed the outcomes of 212 liver transplantations (LTs) performed at 32 European centers. Donors and recipients of both groups were very similar in baseline characteristics. Pretransplant laboratory Model for End-Stage Liver Disease score was not different in recipients of a dopamine-treated versus untreated graft (18 ± 8 versus 20 ± 8; P = 0.12). Mean cold ischemia time was 10.6 ± 2.9 versus 10.1 ± 2.8 hours (P = 0.24). No differences occurred in biopsy-proven rejection episodes (14.4% versus 15.7%; P = 0.85), requirement of hemofiltration (27.9% versus 31.5%; P = 0.65), the need for early retransplantation (5.8% versus 6.5%; P > 0.99), the incidence of primary nonfunction (7.7% versus 8.3%; P > 0.99), and in-hospital mortality (15.4% versus 14.8%; P > 0.99). Graft survival was 71.2% versus 73.2% and 59.6% versus 62.0% at 2 and 3 years (log-rank P = 0.71). Patient survival was 76.0% versus 78.7% and 65.4% versus 69.4% at 1 and 3 years (log-rank P = 0.50). In conclusion, donor pretreatment with dopamine has no short-term or longterm effects on outcome after LT. Therefore, low-dose dopamine pretreatment can safely be implemented as the standard of care in hemodynamically stable DBDs.

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Low-Dose Donor Dopamine Is Associated With a Decreased Risk of Right Heart Failure in Pediatric Heart Transplant Recipients

Cited by 21 publications

References 13 publications

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

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

Donor Preconditioning After the Onset of Brain Death With Dopamine Derivate n-Octanoyl Dopamine Improves Early Posttransplant Graft Function in the Rat

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

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