title: Impact of high-dose inotropic donor support on early myocardial necrosis and outcomes in cardiac transplantation.
abstract: BACKGROUND
  Cardiac donors routinely require vasoactive agents for circulatory stability after brain death. Nevertheless, inotropes have been associated with direct cardiac toxicity. Our study evaluated whether the use of high-dose inotropic support in potential donors was associated with increased early myocardial necrosis (MN) and worse clinical outcomes after cardiac transplantation.
  
  
  METHODS
  The UTAH Cardiac Transplant Program (UCTP) and Intermountain Donor Services databases were queried for records between 1996 and 2009. The high-dose donor inotropic support (HDIS) group was defined as patients on dopamine >10 μg/kg/min. The incidence of early MN, intensive care unit (ICU) length of stay, length of ventilator support, and mortality was evaluated.
  
  
  RESULTS
  Two hundred and forty-four recipients undergoing transplant met study criteria. The average donor age was 27 yr. The incidence of MN in the HDIS (n=29) and non-HDIS (n=204) groups was 14.8% and 6.7%, respectively, OR 2.67. Total ischemic time, ventilator support time, ICU stay, and actuarial survival were similar between both groups.
  
  
  CONCLUSIONS
  The use of high-dose inotropic support to maintain donor stability appears to have a higher trend for early post-transplant MN without an impact on clinical outcomes. With the current growing shortage of organ donors, it appears reasonable to use donors on high-dose inotropic support.
authors: Intermountain Medical Center and Intermountain Healthcare, Salt Lake City, UT, USA.
authors: Jennifer L
authors: JL
authors: Nixon
authors: Abdallah G
authors: AG
authors: Kfoury
authors: Kim
authors: K
authors: Brunisholz
authors: Benjamin D
authors: BD
authors: Horne
authors: Craig
authors: C
authors: Myrick
authors: Dylan V
authors: DV
authors: Miller
authors: Deborah
authors: D
authors: Budge
authors: Feras
authors: F
authors: Bader
authors: Melanie
authors: M
authors: Everitt
authors: Abdulfattah
authors: A
authors: Saidi
authors: Josef
authors: J
authors: Stehlik
authors: Tracy C
authors: TC
authors: Schmidt
authors: Rami
authors: R
authors: Alharethi
mesh_terms: D000293:Adolescent; D000328:Adult; D001926:Brain Death / Q000503:physiopathology; D002316:Cardiotonic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004298:Dopamine / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D006321:Heart / Q000187:drug effects*; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D011183:Postoperative Complications / Q000139:chemically induced*; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting; D055815:Young Adult
chemical_list: D002316:Cardiotonic Agents; D004298:Dopamine