title: Thyroid hormone therapy in the management of 63,593 brain-dead organ donors: a retrospective analysis.
abstract: BACKGROUND
  Hormonal therapy to the brain-dead potential organ donor can include thyroid hormone (triiodothyronine [T3] or levothyroxine [T4]), corticosteroids, antidiuretic hormone, and insulin.
  
  
  METHODS
  Data on 66,629 donors (2000-2009) were retrospectively reviewed. Documentation on T3/T4 was available in 63,593 (study 1), but 23,469 had incomplete documentation of other hormones. In 40,124, details of all four hormones were recorded (study 2). In this cohort, group A (received T3/T4) consisted of 23,022, and group B (no T3/T4) consisted of 17,102 donors. A multivariate analysis was performed to determine whether age, sex, ethnicity, cause of death, body mass index, Organ Procurement Organization region, or other hormonal therapy influenced procurement. Posttransplantation organ graft survival at 1 and 12 months was compared.
  
  
  RESULTS
  In study 1, 30,962 (48.69%) received T3/T4, providing a mean of 3.35 organs per donor, and 32,631 (51.31%) did not receive T3/T4, providing a mean of 2.97 organs per donor, an increase of 12.8% of organs from T3/T4-treated donors (P<0.0001). In study 2, group A provided a mean of 3.31 organs per donor and group B provided a mean of 2.87 organs per donor, an increase of 15.3% in group A (P<0.0001). T3/T4 therapy was associated with procurement of significantly greater numbers of hearts, lungs, kidneys, pancreases, and intestines, but not livers. Multivariate analysis indicated a beneficial effect of T3/T4 independent of other factors (P<0.0001). T3/T4 therapy of the donor was associated with improved posttransplantation graft survival or no difference in survival, except for pancreas recipient (but not graft) survival at 12 months in study 2.
  
  
  CONCLUSIONS
  T3/T4 therapy results in more transplantable organs, with no detriment to posttransplantation graft survival.
authors.affiliation: 1 Formerly Department of Cardiac Surgery, University of South Florida, Tampa, FL. 2 Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD. 3 Department of Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA. 4 Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA. 5 Address correspondence to: David K.C. Cooper, M.D., Ph.D., F.R.C.S., Thomas E. Starzl Transplantation Institute, Starzl Biomedical Science Tower, W1543, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15261.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Novitzky
authors.forename: Zhibao
authors.initials: Z
authors.lastname: Mi
authors.forename: Qing
authors.initials: Q
authors.lastname: Sun
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Collins
authors.forename: David K C
authors.initials: DK
authors.lastname: Cooper
mesh_terms: D000293:Adolescent; D000328:Adult; D001926:Brain Death; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016377:Organ Transplantation; D012189:Retrospective Studies; D016019:Survival Analysis; D013974:Thyroxine / Q000627:therapeutic use*; D013997:Time Factors; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods; D009927:Tissue and Organ Procurement / Q000379:methods*; D014284:Triiodothyronine / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014284:Triiodothyronine; D013974:Thyroxine