Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, UT, USA.
Clin Transplant. 2012 Mar-Apr;26(2):322-7. doi: 10.1111/j.1399-0012.2011.01504.x. Epub 2011 Oct 10.
Cardiac donors routinely require vasoactive agents for circulatory stability after brain death. Nevertheless, inotropes have been associated with direct cardiac toxicity. Our study evaluated whether the use of high-dose inotropic support in potential donors was associated with increased early myocardial necrosis (MN) and worse clinical outcomes after cardiac transplantation.
The UTAH Cardiac Transplant Program (UCTP) and Intermountain Donor Services databases were queried for records between 1996 and 2009. The high-dose donor inotropic support (HDIS) group was defined as patients on dopamine >10 μg/kg/min. The incidence of early MN, intensive care unit (ICU) length of stay, length of ventilator support, and mortality was evaluated.
Two hundred and forty-four recipients undergoing transplant met study criteria. The average donor age was 27 yr. The incidence of MN in the HDIS (n=29) and non-HDIS (n=204) groups was 14.8% and 6.7%, respectively, OR 2.67. Total ischemic time, ventilator support time, ICU stay, and actuarial survival were similar between both groups.
The use of high-dose inotropic support to maintain donor stability appears to have a higher trend for early post-transplant MN without an impact on clinical outcomes. With the current growing shortage of organ donors, it appears reasonable to use donors on high-dose inotropic support.
心脏供体在脑死亡后通常需要血管活性药物来维持循环稳定。然而，正性肌力药物与直接心肌毒性有关。我们的研究评估了在潜在供体中使用高剂量正性肌力支持是否与心脏移植后早期心肌坏死（MN）增加和临床结局恶化相关。
1996 年至 2009 年间，查询了犹他州心脏移植计划（UCTP）和 Intermountain 供体服务数据库中的记录。高剂量供体正性肌力支持（HDIS）组定义为多巴胺>10μg/kg/min 的患者。评估了早期 MN、重症监护病房（ICU）住院时间、呼吸机支持时间和死亡率的发生率。
244 名接受移植的受者符合研究标准。供体的平均年龄为 27 岁。HDIS（n=29）和非-HDIS（n=204）组的 MN 发生率分别为 14.8%和 6.7%，OR 2.67。两组的总缺血时间、呼吸机支持时间、ICU 入住时间和生存率相似。
使用高剂量正性肌力支持来维持供体稳定似乎与移植后早期 MN 发生率增加有关，但对临床结局没有影响。鉴于目前器官捐献者严重短缺，使用高剂量正性肌力支持的供体似乎是合理的。
