Donor hormone and vasopressor therapy: closing the gap in a transplant organ shortage.
BACKGROUND
Hormone replacement therapy (HRT) use for donors with hemodynamic instability is common. The purpose of this study was to determine the effect of HRT in donors without significant cardiovascular dysfunction and examine outcomes according to vasopressor exposure.


METHODS
All successfully procured donors admitted between January 1, 2006, and March 31, 2011, were included. HRT group I were donors without significant hemodynamic instability at the initiation of HRT. Comparison was made to all other donors receiving HRT (HRT group II). Vasopressor use was also examined and compared. High-yield procurement was the successful recovery of ≥ 4 organs.


RESULTS
Forty-seven donors were studied. Most were male (36 [76.6%]) and trauma (41% [87.2%]) predominated. Twenty-two (46.8%) patients were in HRT group I. There were no differences in gender, admission diagnosis, or complications; however, HRT group I had a significantly greater number of organs recovered (4.73 ± 1.42 vs. 3.08 ± 1.19, p < 0.001). Differences in rates for the heart (68.2% vs. 24%, p = 0.002) and lung (40.9% vs. 8.0%, p = 0.008) were marked. HRT group I was more likely managed on a single agent (45.5% vs. 8.0%, p = 0.003). Norepinephrine was associated with a decreased rate of high-yield procurement (48.0% vs. 77.3%, p = 0.039), while vasopressin exposure was associated with an absolute increase (72.0% vs. 59.1%, p = 0.351). After adjusting for differences between groups (particularly age), HRT group I status was independently associated with high-yield procurement.


CONCLUSIONS
A more liberal strategy of HRT seems to significantly increase procurement rates. Vasopressor selection favoring vasopressin as opposed to norepinephrine may also play a role.


METHODS
Therapeutic study, level III.
Division of Trauma/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, California 90509, USA.dplurad@dhs.lacounty.gov
David S
DS
Plurad
Scott
S
Bricker
Ann
A
Falor
Angela
A
Neville
Frederic
F
Bongard
Brant
B
Putnam
D000328:Adult; D001926:Brain Death; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D016027:Heart Transplantation / Q000379:methods; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods; D016031:Liver Transplantation / Q000379:methods; D019520:Living Donors / Q000600:supply & distribution*; D016040:Lung Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000494:pharmacology*; D055815:Young Adult
D014662:Vasoconstrictor Agents