title: Norepinephrine versus dopamine pretreatment of potential heart donors - impact on long-term outcome.
abstract: BACKGROUND
  Current guidelines advocate administration of inotropic agents to stabilize potential deceased heart-beating donors. A consensus on the specific agent or combination therapy is lacking. We thus initiated a retrospective analysis of patients being transplanted at our center in a matched-pair study design focusing on survival after donor pre-treatment either with norepinephrine or dopamine.
  
  
  METHODS
  936 patients (759 male; 177 female; mean age: 47.5 ± 15.4 years) were transplanted at our center between 8/1981 and 12/2010. An overall of 22 patient pairs (all male; mean age 55.4 ± 7.5 years; range 23-67 years) were matched according to our strict criteria. During follow-up (5037 ± 1791 days) 11 deaths occurred. Overall survival in both groups was not different (p=0.1438).
  
  
  RESULTS
  In a sub-population analysis of all patient-pairs that completed 5-year follow-up (n=19), Kaplan-Meier analysis revealed significant superior survival of recipients that received hearts pre-treated with norepinephrine vs. dopamine pre-treatment (p=0.0368).
  
  
  CONCLUSIONS
  Neither norepinephrine nor dopamine pre-treatment of potential heart donors showed superior overall survival. In a sub-population of long-term survivors norepinephrine pre-treatment was associated with better survival in a rather small cohort of heart transplant recipients. These findings underscore the urgent need of further prospective multicenter randomized trials to recommend a preferable adrenergic therapy.
authors.affiliation: Department of Cardiology, Medical Clinic I, Grosshadern Campus, Ludwig-Maximilians-University, Munich, Germany. franz.ziegler@med.uni-muenchen.de
authors.forename: Franz
authors.initials: F
authors.lastname: von Ziegler
authors.forename: Susanne
authors.initials: S
authors.lastname: Helbig
authors.forename: Nicole
authors.initials: N
authors.lastname: Kreissl
authors.forename: Bruno
authors.initials: B
authors.lastname: Meiser
authors.forename: Alexander
authors.initials: A
authors.lastname: Becker
authors.forename: Ingo
authors.initials: I
authors.lastname: Kaczmarek
mesh_terms: D000328:Adult; D000368:Aged; D001926:Brain Death; D004298:Dopamine / Q000008:administration & dosage*; D005260:Female; D005858:Germany / Q000453:epidemiology; D016027:Heart Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage*; D012189:Retrospective Studies; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004298:Dopamine; D009638:Norepinephrine