title: Increased Procurement of Thoracic Donor Organs After Thyroid Hormone Therapy.
abstract: Hormonal therapy to the brain-dead organ donor can include thyroid hormone (triiodothyronine [T3] or levothyroxine [T4]), antidiuretic hormone, corticosteroids, or insulin. There has been a controversy on whether thyroid hormone enables more organs to be procured. Data on 63,593 donors of hearts and lungs (2000-2009) were retrospectively reviewed. Documentation on T3/T4 was available in all donors (study 1), and in 40,124 details of all 4 hormones were recorded (study 2). In this cohort, group A (23,022) received T3/T4 and group B (17,102) no T3/T4. Univariate analyses and multiple regressions were performed. Posttransplant graft and recipient survival at 1 and 12 months were compared. In study 1, 30,962 donors received T3/T4, with 36.59% providing a heart and 20.05% providing 1 or both lungs. Of the 32,631 donors who did not receive T3/T4, only 29.62% provided a heart and 14.61% provided lungs, an increase of 6.97% hearts and 5.44% lungs from T3/T4-treated donors (both P < 0.0001). In study 2, 34.99% of group A provided a heart and 20.99% provided lungs. In group B only 25.76% provided a heart and 15.09% provided lungs, an increase of 9.23% (hearts) and 5.90% (lungs), respectively, in group A (both P < 0.0001). The results of multiple regression analyses indicated a beneficial effect of T3/T4 on heart (P < 0.0001) and lung (P < 0.0001) procurement independent of other factors. T3/T4 therapy to the donor was associated with either improved posttransplant graft and recipient survival or no difference in survival. T3/T4 therapy results in more transplantable hearts and lungs, with no detriment to posttransplant graft or recipient survival.
authors.affiliation: Cardiothoracic Surgery, University of South Florida, Tampa, Florida.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Novitzky
authors.affiliation: Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, Maryland.
authors.forename: Zhibao
authors.initials: Z
authors.lastname: Mi
authors.affiliation: Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, Maryland.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Collins
authors.affiliation: Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: cooperdk@upmc.edu.
authors.forename: David K C
authors.initials: DK
authors.lastname: Cooper
mesh_terms: D000328:Adult; D001926:Brain Death; D016009:Chi-Square Distribution; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013974:Thyroxine / Q000627:therapeutic use*; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014284:Triiodothyronine / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014284:Triiodothyronine; D013974:Thyroxine
keywords: brain death; heart; lung; organ donation; thyroid hormone; transplantation