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Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
Steroid pretreatment of organ donors to prevent postischemic renal allograft failure: a randomized, controlled trial
Alexander Kainz1, Julia Wilflingseder, Christa Mitterbauer
1Medical University of Vienna, Vienna, Austria. alexander.kainz@meduniwien.ac.at
Annals of Internal Medicine
|August 18, 2010
Summary
Administering corticosteroids to deceased organ donors did not reduce the incidence or duration of posttransplantation acute renal failure (ARF) in recipients. Inflammation in donor organs is linked to ARF risk, but this intervention showed no significant benefit.
Area of Science:
- Nephrology
- Transplantation Immunology
- Critical Care Medicine
Background:
- Posttransplantation acute renal failure (ARF) affects approximately 25% of deceased donor organ recipients.
- Inflammation within the donor organ is a known risk factor for ARF.
- Current strategies aim to mitigate ARF risk in transplant recipients.
Purpose of the Study:
- To evaluate the efficacy of administering corticosteroids to deceased organ donors in reducing ARF incidence and duration.
- To compare outcomes between organ recipients whose donors received methylprednisolone versus placebo.
- To investigate the impact of donor corticosteroid administration on inflammation and immune response.
Main Methods:
- A parallel, blocked randomized controlled trial involving 306 deceased heart-beating donors and 455 renal transplant recipients.
- Donors received either intravenous methylprednisolone (1000 mg) or placebo (0.9% saline) at least 3 hours prior to organ procurement.
- ARF incidence (defined by dialysis requirement) and serum creatinine trajectories were primary endpoints, with genomic analysis of donor organs for inflammation markers.
Main Results:
- The incidence of ARF was similar between the steroid group (22%) and the placebo group (25%).
- Median duration of ARF was 5 days in the steroid group versus 4 days in the placebo group (P = 0.31).
- Genomic analysis confirmed suppressed inflammation and immune response in donor kidneys from the corticosteroid group, despite no clinical benefit.
Conclusions:
- Systemic administration of corticosteroids to deceased organ donors does not decrease the incidence or duration of posttransplantation ARF in allograft recipients.
- The study highlights a dissociation between donor-level inflammatory markers and recipient clinical outcomes.
- Generalizability may be limited due to the study population being primarily Caucasian and from three European centers.
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