Dupuis S, Amiel J-A, Desgroseilliers M, Williamson D R, Thiboutot Z, Serri K, Perreault M M, Marsolais P, Frenette A J
Faculté de Pharmacie, Université de Montréal, C.P. 6128, succursale Centre-Ville, Montreal, QC, Canada H3C 3J7 Pharmacy Department, McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, Canada H3G 1A4 Pharmacy Department and
Faculté de Pharmacie, Université de Montréal, C.P. 6128, succursale Centre-Ville, Montreal, QC, Canada H3C 3J7 Pharmacy Department, McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, Canada H3G 1A4.
Br J Anaesth. 2014 Sep;113(3):346-59. doi: 10.1093/bja/aeu154. Epub 2014 Jun 30.
Summary Current guidelines recommend the administration of hormonal combination therapy including immunosuppressive doses of corticosteroids to donors with low left ventricular ejection fractions and to consider hormonal therapy administration to all donors. However, these recommendations are largely based on observational data. The aim of this systematic review (SR) was to assess the clinical efficacy and safety of corticosteroids in brain-dead potential organ donors. MEDLINE and EMBASE were searched from the earliest accessible date up to March 2013 with a qualified librarian. Studies comparing the effects of any corticosteroid with those of placebo, standard treatment, or another active comparator were sought. Two independent reviewers evaluated each citation retrieved and selected studies independently and in duplicate. A third independent reviewer resolved any disagreement. Outcomes included donor haemodynamics and oxygenation, organ procurement, recipient survival, and graft survival. This review included 11 randomized controlled trials (RCTs) and 14 observational studies. The majority used methylprednisolone and often combined it with other hormonal therapies. Ten out of the 11 RCTs yielded neutral results. However, in observational studies, use of corticosteroids generally resulted in improved donor haemodynamics and oxygenation status, increased organ procurement, and improved recipient and graft survival. Overall quality of included studies was poor, as most of them presented high risks of confounding. This SR highlights the low quality and conflicting evidence supporting the routine use of corticosteroids in the management of organ donors. A large trial evaluating the effect of corticosteroids on outcomes such as organ recovery and graft survival is warranted.
摘要 当前指南建议对左心室射血分数低的供体给予包括免疫抑制剂量皮质类固醇的激素联合治疗，并考虑对所有供体给予激素治疗。然而，这些建议很大程度上基于观察性数据。本系统评价（SR）的目的是评估皮质类固醇在脑死亡潜在器官供体中的临床疗效和安全性。在一名合格图书馆员的协助下，检索了MEDLINE和EMBASE数据库，检索时间从最早可获取日期至2013年3月。寻找比较任何皮质类固醇与安慰剂、标准治疗或另一种活性对照药物效果的研究。两名独立评审员分别独立且重复地评估每篇检索到的文献并选择研究。第三名独立评审员解决任何分歧。结局指标包括供体的血流动力学和氧合、器官获取、受者生存和移植物生存。本评价纳入了11项随机对照试验（RCT）和14项观察性研究。大多数研究使用甲泼尼龙，且常将其与其他激素疗法联合使用。11项RCT中有10项得出中性结果。然而，在观察性研究中，使用皮质类固醇通常可改善供体的血流动力学和氧合状态，增加器官获取，并改善受者和移植物生存。纳入研究的总体质量较差，因为大多数研究存在高混杂风险。本系统评价强调了支持在器官供体管理中常规使用皮质类固醇的证据质量低且相互矛盾。有必要进行一项大型试验来评估皮质类固醇对器官恢复和移植物生存等结局的影响。
