title: Donor desmopressin is associated with superior graft survival after kidney transplantation.
abstract: BACKGROUND
  A recent randomized trial showed that pretreatment of the brain-dead donor with low-dose dopamine improves immediate kidney graft function, by limiting injury from cold storage (ClinicalTrials.gov Identifier: NCT00115115). This study determines whether donor exposure to desmopressin (1-deamino-8-d-arginine-vasopressin [DDAVP]) before organ retrieval affects renal transplant outcome.
  
  
  METHODS
  This retrospective multicenter cohort study, nested in the database of the dopamine trial, includes 264 deceased heart-beating donors with confirmed brain death and corresponding 487 renal allograft recipients transplanted at 60 European centers between March 2004 and August 2007. We assessed differences in delayed graft function, biopsy-proven acute rejections, and 2-year kidney graft survival in recipients of a DDAVP-exposed versus unexposed graft.
  
  
  RESULTS
  DDAVP was associated with improved graft survival (85.4% vs. 73.6%, P=0.003). This survival benefit persisted after censoring for death with functioning graft (91.1% vs. 82.0%, P=0.01) and after adjustment for confounders including covariate adjustment from propensity scoring (hazard ratio 0.40, 95% confidence interval [CI] 0.21-0.77; P=0.006). Delayed graft function (odds ratio 0.97, 95% CI 0.57-1.65; P=0.92) and biopsy-proven acute rejections (odds ratio 1.32, 95% CI 0.70-2.49; P=0.40) were unaffected. The survival effect was enhanced after a shorter cold ischemic time less than 14 hr (91.3% vs. 77.8%, P=0.008) and after dopamine pretreatment (92.7% vs. 78.6%, P=0.006). By contrast, prolonged cold ischemic time more than or equal to 14 hr (91.2% vs. 86.5%, P=0.39) and assignment to the nondopamine group (89.7% vs. 84.8%, P=0.37) abrogated the survival advantage.
  
  
  CONCLUSIONS
  Donor DDAVP seems to improve renal allograft survival. Combined use of donor DDAVP and low-dose dopamine should receive further evaluation.
authors: 5th Department of Medicine, University Medical Centre Mannheim, Mannheim, Germany.
authors: Urs
authors: U
authors: Benck
authors: Uwe
authors: U
authors: Gottmann
authors: Simone
authors: S
authors: Hoeger
authors: Alexander
authors: A
authors: Lammert
authors: Daniela
authors: D
authors: Rose
authors: Detlef
authors: D
authors: Boesebeck
authors: Werner
authors: W
authors: Lauchart
authors: Rainer
authors: R
authors: Birck
authors: Christel
authors: C
authors: Weiss
authors: Bernhard K
authors: BK
authors: Krämer
authors: Benito A
authors: BA
authors: Yard
authors: Peter
authors: P
authors: Schnuelle
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D050377:Cold Ischemia; D003894:Deamino Arginine Vasopressin / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000187:drug effects* / Q000473:pathology; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors
chemical_list: D003894:Deamino Arginine Vasopressin