title: Effects of donor pretreatment with dopamine on graft function after kidney transplantation: a randomized controlled trial.
abstract: BACKGROUND
  Kidney graft function after transplantation can be improved through pharmacological donor pretreatment to limit organ injury from cold preservation.
  
  
  OBJECTIVE
  To determine whether pretreatment of brain-dead donors with low-dose dopamine improves early graft function in human renal transplant recipients.
  
  
  METHODS
  Randomized, open-label, multicenter, parallel-group trial of 264 deceased heart-beating donors and 487 subsequent renal transplants performed at 60 European centers between March 2004 and August 2007 (final follow-up, December 31, 2008). Eligible donors were stable under low-dose norepinephrine with a normal serum creatinine concentration on admission.
  
  
  METHODS
  Donors were randomized to receive low-dose dopamine (4 mug/kg/min).
  
  
  METHODS
  Dialysis requirement during first week after transplantation.
  
  
  RESULTS
  Dopamine was infused for a median of 344 minutes (IQR, 215 minutes). Dialysis was significantly reduced in recipients of a dopamine-treated graft. Fewer recipients in the treatment group needed multiple dialyses (56/227; 24.7%; 95% CI, 19.0%-30.3%; vs 92/260; 35.4%; 95% CI, 29.5%-41.2%; P = .01). The need for multiple dialyses posttransplant was associated with allograft failure after 3 years (HR, 3.61; 95% CI, 2.39-5.45; P < .001), whereas a single dialysis was not (HR, 0.67; 95% CI, 0.21-2.18; P = .51). Besides donor dopamine (OR, 0.54; 95% CI, 0.35-0.83; P = .005), cold ischemic time (OR, 1.07; 95% CI, 1.02-1.11 per hour; P = .001), donor age (OR, 1.03; 95% CI, 1.01-1.05 per year; P < .001), and recipient body weight (OR, 1.02; 95% CI, 1.01-1.04 per kg; P = .009) were independent explanatory variables in a multiple logistic regression model. Dopamine resulted in significant but clinically meaningless increases in the donor's systolic blood pressure (3.8 mm Hg; 95% CI, 0.7-6.9 mm Hg; P = .02) and urine production before surgical recovery of the kidneys (29 mL; 95% CI, 7-51 mL; P = .009) but had no influence on outcome.
  
  
  CONCLUSIONS
  Donor pretreatment with low-dose dopamine reduces the need for dialysis after kidney transplantation.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00115115.
authors.affiliation: University Medical Centre Mannheim, 5th Department of Medicine, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany. peter.schnuelle@med5.ma.uni-heidelberg.de
authors.forename: Peter
authors.initials: P
authors.lastname: Schnuelle
authors.forename: Uwe
authors.initials: U
authors.lastname: Gottmann
authors.forename: Simone
authors.initials: S
authors.lastname: Hoeger
authors.forename: Detlef
authors.initials: D
authors.lastname: Boesebeck
authors.forename: Werner
authors.initials: W
authors.lastname: Lauchart
authors.forename: Christel
authors.initials: C
authors.lastname: Weiss
authors.forename: Michael
authors.initials: M
authors.lastname: Fischereder
authors.forename: Karl-Walter
authors.initials: KW
authors.lastname: Jauch
authors.forename: Uwe
authors.initials: U
authors.lastname: Heemann
authors.forename: Martin
authors.initials: M
authors.lastname: Zeier
authors.forename: Christian
authors.initials: C
authors.lastname: Hugo
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Pisarski
authors.forename: Bernhard K
authors.initials: BK
authors.lastname: Krämer
authors.forename: Kai
authors.initials: K
authors.lastname: Lopau
authors.forename: Axel
authors.initials: A
authors.lastname: Rahmel
authors.forename: Urs
authors.initials: U
authors.lastname: Benck
authors.forename: Rainer
authors.initials: R
authors.lastname: Birck
authors.forename: Benito Antonio
authors.initials: BA
authors.lastname: Yard
mesh_terms: D000328:Adult; D001926:Brain Death; D004298:Dopamine / Q000494:pharmacology / Q000627:therapeutic use*; D015259:Dopamine Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation; D055031:Primary Graft Dysfunction / Q000517:prevention & control; D011446:Prospective Studies; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D014019:Tissue Donors
chemical_list: D015259:Dopamine Agents; D004298:Dopamine