Effects of donor pretreatment with dopamine on graft function after kidney transplantation: a randomized controlled trial.
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.
Schnuelle
Peter
P
University Medical Centre Mannheim, 5th Department of Medicine, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany. peter.schnuelle@med5.ma.uni-heidelberg.de
Gottmann
Uwe
U
Hoeger
Simone
S
Boesebeck
Detlef
D
Lauchart
Werner
W
Weiss
Christel
C
Fischereder
Michael
M
Jauch
Karl-Walter
KW
Heemann
Uwe
U
Zeier
Martin
M
Hugo
Christian
C
Pisarski
Przemyslaw
P
Krämer
Bernhard K
BK
Lopau
Kai
K
Rahmel
Axel
A
Benck
Urs
U
Birck
Rainer
R
Yard
Benito Antonio
BA
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
D015259:Dopamine Agents; D004298:Dopamine