Effects of catecholamine application to brain-dead donors on graft survival in solid organ transplantation.
BACKGROUND
In a recent single-center study, donor use of catecholamines was identified to reduce kidney allograft rejection. This study investigates the effects of donor employment of adrenergic agents on graft survival in a large data base, including liver and heart transplants.


METHODS
The study was based on the registry of the Eurotransplant International Foundation including 2415 kidney, 755 liver, and 720 heart transplants performed between January 1 and December 31, 1993. A total of 1742 donor record forms referring to the cadaveric donor activities in 1993 were systematically reviewed with regard to employment of adrenergic agents. Catecholamine use was simply coded dichotomously and divided into three strata according to zero, single, and combined application. Multivariate Cox regression including age, gender, cause of brain death, cold ischemia, HLA-mismatching, number of previous transplants, and urgency in liver transplants was applied for statistical analysis.


RESULTS
Donor employment of catecholamines was associated with increased 4-year graft survival after kidney transplantation (hazard ratio [HR], 0.85; 95% confidence interval [95% CI], 0.74-0.98). The benefit is conferred in a dose-dependent manner and compares in quantitative terms with prospective HLA matching on class I and class II antigens (HR, 0.90; 95% CI, 0.84-0.97). Use of norepinephrine was predictive of initial nonfunction after heart transplantation (HR, 1.66; 95% CI, 1.14-2.43), but did not compromise liver grafts (HR, 0.94; 95% CI, 0.67-1.32).


CONCLUSIONS
Optimizing the management of brain-dead organ donors, including the possibility of selective administration of adrenergic agents, may provide a major benefit on graft survival without adverse side effects for the recipients. Further investigation on best use of adrenergic drugs, optimum dosage, and duration is warranted.
Schnuelle
P
P
University Hospital Mannheim, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany. schnuell@rumms.uni-mannheim.de
Berger
S
S
de Boer
J
J
Persijn
G
G
van der Woude
F J
FJ
D000328:Adult; D001926:Brain Death; D002395:Catecholamines / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006085:Graft Survival / Q000187:drug effects*; D006321:Heart / Q000187:drug effects; D016027:Heart Transplantation; D006801:Humans; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009638:Norepinephrine / Q000009:adverse effects / Q000627:therapeutic use; D016016:Proportional Hazards Models; D013997:Time Factors; D014019:Tissue Donors
D002395:Catecholamines; D009638:Norepinephrine