title: Corticosteroids in the management of brain-dead potential organ donors: a systematic review.
abstract: Summary Current guidelines recommend the administration of hormonal combination therapy including immunosuppressive doses of corticosteroids to donors with low left ventricular ejection fractions and to consider hormonal therapy administration to all donors. However, these recommendations are largely based on observational data. The aim of this systematic review (SR) was to assess the clinical efficacy and safety of corticosteroids in brain-dead potential organ donors. MEDLINE and EMBASE were searched from the earliest accessible date up to March 2013 with a qualified librarian. Studies comparing the effects of any corticosteroid with those of placebo, standard treatment, or another active comparator were sought. Two independent reviewers evaluated each citation retrieved and selected studies independently and in duplicate. A third independent reviewer resolved any disagreement. Outcomes included donor haemodynamics and oxygenation, organ procurement, recipient survival, and graft survival. This review included 11 randomized controlled trials (RCTs) and 14 observational studies. The majority used methylprednisolone and often combined it with other hormonal therapies. Ten out of the 11 RCTs yielded neutral results. However, in observational studies, use of corticosteroids generally resulted in improved donor haemodynamics and oxygenation status, increased organ procurement, and improved recipient and graft survival. Overall quality of included studies was poor, as most of them presented high risks of confounding. This SR highlights the low quality and conflicting evidence supporting the routine use of corticosteroids in the management of organ donors. A large trial evaluating the effect of corticosteroids on outcomes such as organ recovery and graft survival is warranted.
authors: Faculté de Pharmacie, Université de Montréal, C.P. 6128, succursale Centre-Ville, Montreal, QC, Canada H3C 3J7 Pharmacy Department, McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, Canada H3G 1A4 Pharmacy Department and sebastien.dupuis.1@umontreal.ca.
authors: S
authors: S
authors: Dupuis
authors: Faculté de Pharmacie, Université de Montréal, C.P. 6128, succursale Centre-Ville, Montreal, QC, Canada H3C 3J7 Pharmacy Department, McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, Canada H3G 1A4.
authors: J-A
authors: JA
authors: Amiel
authors: Faculté de Pharmacie, Université de Montréal, C.P. 6128, succursale Centre-Ville, Montreal, QC, Canada H3C 3J7 Pharmacy Department, Hôpital Honoré Mercier, 2750 Laframboise boul., St-Hyacinthe, QC, Canada J2S 4Y8.
authors: M
authors: M
authors: Desgroseilliers
authors: Faculté de Pharmacie, Université de Montréal, C.P. 6128, succursale Centre-Ville, Montreal, QC, Canada H3C 3J7 Pharmacy Department and.
authors: D R
authors: DR
authors: Williamson
authors: Pharmacy Department, Centre Hospitalier Universitaire de Montreal, 1560 Sherbrooke E, Montreal, QC, Canada H2L 4M1.
authors: Z
authors: Z
authors: Thiboutot
authors: Department of Critical Care, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin W, Montreal, QC, Canada H4J 1C5 Faculté de Médecine, Université de Montréal, Pavillon Roger-Gaudry, 2900 Edouard-Montpetit, Montreal, QC, Canada H3T 1J4.
authors: K
authors: K
authors: Serri
authors: Faculté de Pharmacie, Université de Montréal, C.P. 6128, succursale Centre-Ville, Montreal, QC, Canada H3C 3J7 Pharmacy Department, McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, Canada H3G 1A4.
authors: M M
authors: MM
authors: Perreault
authors: Department of Critical Care, Hôpital du Sacré-Coeur de Montréal, 5400 Gouin W, Montreal, QC, Canada H4J 1C5 Faculté de Médecine, Université de Montréal, Pavillon Roger-Gaudry, 2900 Edouard-Montpetit, Montreal, QC, Canada H3T 1J4.
authors: P
authors: P
authors: Marsolais
authors: Faculté de Pharmacie, Université de Montréal, C.P. 6128, succursale Centre-Ville, Montreal, QC, Canada H3C 3J7 Pharmacy Department and.
authors: A J
authors: AJ
authors: Frenette
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D001926:Brain Death; D006085:Graft Survival / Q000187:drug effects*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008775:Methylprednisolone / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D020858:Tissue and Organ Harvesting / Q000379:methods*; D009927:Tissue and Organ Procurement / Q000379:methods*
chemical_list: D000305:Adrenal Cortex Hormones; D008775:Methylprednisolone
keywords: adrenal cortex hormones; brain death; human; systematic review; tissue and organ procurement; transplantation