University Medical Centre Mannheim, Mannheim, Germany.
J Am Coll Cardiol. 2011 Oct 18;58(17):1768-77. doi: 10.1016/j.jacc.2011.05.060.
We determined the outcome of cardiac allografts from multiorgan donors enrolled in a randomized trial of donor pre-treatment with dopamine.
Treatment of the brain-dead donor with low-dose dopamine improves immediate graft function after kidney transplantation.
A cohort study of 93 heart transplants from 21 European centers was undertaken between March 2004 and August 2007. We assessed post-transplant left ventricular function (LVF), requirement of a left ventricular assist device (LVAD) or biventricular assist device (BVAD), need for hemofiltration, acute rejection, and survival of recipients of a dopamine-treated versus untreated graft.
Donor dopamine was associated with improved survival 3 years after transplantation (87.0% vs. 67.8%, p = 0.03). Fewer recipients of a pre-treated graft required hemofiltration after transplant (21.7% vs. 40.4%, p = 0.05). Impaired LVF (15.2% vs. 21.3%, p = 0.59), requirement of a LVAD (4.4% vs. 10.6%, p = 0.44), and biopsy-proven acute rejection (19.6% vs. 14.9%, p = 0.59) were not statistically different between groups. Post-transplant impaired LVF (hazard ratio [HR]: 4.95; 95% confidence interval [CI]: 2.08 to 11.79; p < 0.001), requirement of LVAD (HR: 6.65; 95% CI: 2.40 to 18.45; p < 0.001), and hemofiltration (HR: 2.83; 95% CI: 1.20 to 6.69; p = 0.02) were predictive of death. The survival benefit remained (HR: 0.33; 95% CI: 0.12 to 0.89; p = 0.03) after adjustment for various risks affecting mortality, including pre-transplant LVAD/BVAD, inotropic support, and impaired kidney function.
Treatment of brain-dead donors with dopamine of 4 μg/kg/min will not harm cardiac allografts but appears to improve the clinical course of the heart allograft recipient. (Prospective Randomized Trial to Evaluate the Efficacy of Donor Preconditioning With Dopamine on Initial Graft Function After Kidney Transplantation; NCT00115115).
我们确定了多巴胺预处理供体的多器官供体心脏移植物的结果，这些供体参与了一项随机试验。
用低剂量多巴胺治疗脑死亡供体可改善肾移植后即刻移植物功能。
2004 年 3 月至 2007 年 8 月，在欧洲 21 个中心进行了 93 例心脏移植的队列研究。我们评估了移植后左心室功能（LVF）、左心室辅助装置（LVAD）或双心室辅助装置（BVAD）的需求、血液滤过的需求、急性排斥反应以及接受多巴胺治疗和未治疗移植物的受者的存活率。
供体多巴胺与移植后 3 年的存活率提高相关（87.0%对 67.8%，p = 0.03）。接受预处理移植物的受者在移植后需要血液滤过的比例较低（21.7%对 40.4%，p = 0.05）。LVF 受损（15.2%对 21.3%，p = 0.59）、需要 LVAD（4.4%对 10.6%，p = 0.44）和活检证实的急性排斥反应（19.6%对 14.9%，p = 0.59）在两组之间无统计学差异。移植后 LVF 受损（危险比[HR]：4.95；95%置信区间[CI]：2.08 至 11.79；p < 0.001）、需要 LVAD（HR：6.65；95%CI：2.40 至 18.45；p < 0.001）和血液滤过（HR：2.83；95%CI：1.20 至 6.69；p = 0.02）是死亡的预测因素。在调整影响死亡率的各种风险（包括移植前 LVAD/BVAD、正性肌力支持和肾功能受损）后，生存获益仍然存在（HR：0.33；95%CI：0.12 至 0.89；p = 0.03）。
4μg/kg/min 的多巴胺治疗脑死亡供体不会损害心脏移植物，但似乎改善了心脏移植物受者的临床过程。（前瞻性随机试验，评估多巴胺预处理供体对肾移植后初始移植物功能的疗效；NCT00115115）。
