title: Effects of donor pre-treatment with dopamine on survival after heart transplantation: a cohort study of heart transplant recipients nested in a randomized controlled multicenter trial.
abstract: OBJECTIVE
  We determined the outcome of cardiac allografts from multiorgan donors enrolled in a randomized trial of donor pre-treatment with dopamine.
  
  
  BACKGROUND
  Treatment of the brain-dead donor with low-dose dopamine improves immediate graft function after kidney transplantation.
  
  
  METHODS
  A cohort study of 93 heart transplants from 21 European centers was undertaken between March 2004 and August 2007. We assessed post-transplant left ventricular function (LVF), requirement of a left ventricular assist device (LVAD) or biventricular assist device (BVAD), need for hemofiltration, acute rejection, and survival of recipients of a dopamine-treated versus untreated graft.
  
  
  RESULTS
  Donor dopamine was associated with improved survival 3 years after transplantation (87.0% vs. 67.8%, p = 0.03). Fewer recipients of a pre-treated graft required hemofiltration after transplant (21.7% vs. 40.4%, p = 0.05). Impaired LVF (15.2% vs. 21.3%, p = 0.59), requirement of a LVAD (4.4% vs. 10.6%, p = 0.44), and biopsy-proven acute rejection (19.6% vs. 14.9%, p = 0.59) were not statistically different between groups. Post-transplant impaired LVF (hazard ratio [HR]: 4.95; 95% confidence interval [CI]: 2.08 to 11.79; p < 0.001), requirement of LVAD (HR: 6.65; 95% CI: 2.40 to 18.45; p < 0.001), and hemofiltration (HR: 2.83; 95% CI: 1.20 to 6.69; p = 0.02) were predictive of death. The survival benefit remained (HR: 0.33; 95% CI: 0.12 to 0.89; p = 0.03) after adjustment for various risks affecting mortality, including pre-transplant LVAD/BVAD, inotropic support, and impaired kidney function.
  
  
  CONCLUSIONS
  Treatment of brain-dead donors with dopamine of 4 μg/kg/min will not harm cardiac allografts but appears to improve the clinical course of the heart allograft recipient. (Prospective Randomized Trial to Evaluate the Efficacy of Donor Preconditioning With Dopamine on Initial Graft Function After Kidney Transplantation; NCT00115115).
authors: University Medical Centre Mannheim, Mannheim, Germany.
authors: Urs
authors: U
authors: Benck
authors: Simone
authors: S
authors: Hoeger
authors: Paul T
authors: PT
authors: Brinkkoetter
authors: Uwe
authors: U
authors: Gottmann
authors: Duygu
authors: D
authors: Doenmez
authors: Detlef
authors: D
authors: Boesebeck
authors: Werner
authors: W
authors: Lauchart
authors: Jan
authors: J
authors: Gummert
authors: Matthias
authors: M
authors: Karck
authors: Hans B
authors: HB
authors: Lehmkuhl
authors: Hartmuth B
authors: HB
authors: Bittner
authors: Andreas
authors: A
authors: Zuckermann
authors: Florian
authors: F
authors: Wagner
authors: Uwe
authors: U
authors: Schulz
authors: Achim
authors: A
authors: Koch
authors: Amir K
authors: AK
authors: Bigdeli
authors: Christoph
authors: C
authors: Bara
authors: Stephan
authors: S
authors: Hirt
authors: Michael
authors: M
authors: Berchtold-Herz
authors: Stefan
authors: S
authors: Brose
authors: Ulf
authors: U
authors: Herold
authors: Johannes
authors: J
authors: Boehm
authors: Henryk
authors: H
authors: Welp
authors: Thomas
authors: T
authors: Strecker
authors: Andreas
authors: A
authors: Doesch
authors: Rainer
authors: R
authors: Birck
authors: Bernhard K
authors: BK
authors: Krämer
authors: Benito A
authors: BA
authors: Yard
authors: Peter
authors: P
authors: Schnuelle
mesh_terms: D000328:Adult; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D004298:Dopamine / Q000008:administration & dosage*; D005260:Female; D006085:Graft Survival / Q000187:drug effects*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D002316:Cardiotonic Agents; D004298:Dopamine