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Norepinephrine versus dopamine pretreatment of potential heart donors - impact on long-term outcome
Franz von Ziegler1, Susanne Helbig, Nicole Kreissl
1Department of Cardiology, Medical Clinic I, Grosshadern Campus, Ludwig-Maximilians-University, Munich, Germany. franz.ziegler@med.uni-muenchen.de
Insights
Norepinephrine or dopamine donor pre-treatment showed no overall survival benefit in heart transplant recipients. However, norepinephrine was linked to better long-term survival in a small subgroup, indicating a need for further trials.
Area of Science:
- Cardiology
- Transplantation Medicine
- Critical Care Medicine
Background:
- Current guidelines recommend inotropic agents for deceased heart-beating donors.
- No consensus exists on the optimal agent or combination therapy.
- This study retrospectively analyzed donor pre-treatment with norepinephrine versus dopamine.
Purpose of the Study:
- To compare the survival outcomes of heart transplant recipients based on donor pre-treatment with norepinephrine or dopamine.
- To investigate the long-term efficacy of different inotropic agents in donor management.
Main Methods:
- Retrospective analysis of 936 heart transplant recipients.
- Matched-pair study design comparing 22 donor-recipient pairs (norepinephrine vs. dopamine).
- Follow-up duration of 5037 ± 1791 days.
Main Results:
- Overall survival did not differ significantly between the norepinephrine and dopamine groups (p=0.1438).
- In a sub-population of 19 pairs with 5-year follow-up, norepinephrine pre-treatment showed significantly superior survival (p=0.0368).
Conclusions:
- Neither norepinephrine nor dopamine pre-treatment demonstrated superior overall survival in heart transplant recipients.
- Norepinephrine pre-treatment was associated with improved survival in a small cohort of long-term survivors.
- Further prospective, multicenter randomized trials are needed to establish optimal adrenergic therapy for organ donors.
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.
Material And 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.
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