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用多巴胺对移植后移植功能的供体预治疗的影响:一项随机对照试验
Peter Schnuelle1, Uwe Gottmann, Simone Hoeger
1University Medical Centre Mannheim, 5th Department of Medicine, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany. peter.schnuelle@med5.ma.uni-heidelberg.de
JAMA
|September 10, 2009
概括
用低剂量的多巴胺预先治疗脏捐赠者显著降低了接受者的透析需求. 这种捐赠者预治疗策略可以改善移植后的早期移植功能.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 移植免疫学 移植免疫学
- 药理学 药理学是指药理学的学科.
背景情况:
- 移植后脏移植功能可以通过药理预先治疗捐赠者来增强,以减轻冷保存损伤.
- 捐赠者预治疗策略旨在改善移植接受者的结果.
研究的目的:
- 评估低剂量多巴胺对脑死亡捐赠者的预治疗是否能改善人类移植接受者的早期移植功能.
- 评估捐赠者多巴胺给药对移植后透析需求的影响.
主要方法:
- 一个随机的,开放的,多中心的试验,涉及264名已故的心跳捐赠者和60个欧洲中心的487个脏移植.
- 供体被随机分配,接受低剂量多巴胺 (4克/千克/分钟) 或标准护理.
- 主要结局指标是移植后第一周需要透析.
主要成果:
- 与对照组相比,多巴胺治疗组中需要多次透析的接受者较少 (24.7%) (35.4%;P = .01).
- 多次移植后透析的需要与3年后的全移植失败增加有关 (HR, 3.61).
- 供体多巴胺的使用,冷血性缺血时间,供体年龄和受体体重是结果的独立预测因素.
结论:
- 用低剂量的多巴胺对捐赠者的预治疗有效地减少了在移植后早期的透析需求.
- 这种干预措施有望改善早期移植功能和潜在的长期结果.
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