Center for Renal Diseases, Weinheim, Germany.
Vth Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.
Clin Transplant. 2018 Jul;32(7):e13292. doi: 10.1111/ctr.13292. Epub 2018 Jun 19.
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.
近年来，由于肾剂量多巴胺在预防重症患者即将发生或改善明显肾衰竭方面无效，因此在重症监护病房（ICU）中已不再受欢迎。相比之下，越来越多的证据表明，脑死亡确认后给予稳定的器官供体低剂量多巴胺可改善肾和心脏移植后移植器官的临床过程。在已故供体中，确保对潜在循环副作用进行彻底监测，以 4μg/kg/min 的剂量使用多巴胺是安全的。在受者中，有利的效果很容易实现，成本低廉，且无不良副作用。作用方式依赖于多巴胺减轻冷藏条件下各种细胞系统中孤立移植器官损伤的倾向。本文综述了多巴胺供体预处理在实体器官移植中的临床证据，并重点介绍了细胞保护的潜在分子机制。在 ICU 中采集器官前，将低剂量多巴胺常规用于管理脑死亡供体，为改善肾移植后的移植物预后提供了循证策略，而不会对多器官捐献情况下的非肾移植物（即肝脏和心脏）造成损害。
