BIOLOGIC AND THERAPEUTIC ADVANCES IN HEART TRANSPLANTATION I

U.T. Benck¹, S. Hoeger², U. Goettmann¹, D. Doenmez¹, B. Yard², P. Schnuelle^1
15th Medical Clinic, University Medical Centre, Mannheim/GERMANY, ²V. Medical Clinic, University Hospital Mannheim, Mannheim/GERMANY

Body: Introduction Treatment of the deceased heart-beating donor with low-dose dopamine results in less dialysis requirement after kidney transplantation. This study investigates the development of all cardiac allografts from multi-organ donors that were enrolled in the randomized dopamine trial (clinicaltrials.gov Identifier: NCT00115115). Methods Between March 2004 and August 2007, 264 brain-dead donors were randomly assigned to receive or to not receive low-dose dopamine. Eligibility criteria included circulatory stability under low-dose norepinephrine. The present investigation was initiated under safety considerations and is nested in the multicenter randomized controlled trial on donor pretreatment with dopamine. We assessed the outcomes of 99 cardiac transplants performed at 22 European centers. Results Dopamine was infused for a median duration of 400 minutes [IQR 232 minutes]. Donors and recipients were very similar in demographic and clinical baseline characteristics. Fewer recipients of a pretreated graft required renal replacement therapy immediately after transplantation[p=0.05]. Furthermore, a combined endpoint of early graft funtion comprising the need for a ventricular assist device and left ventricular function was in favor of the dopamine pretreated grafts [p=0.07]. The beneficial effects were particularly enhanced when dopamine was applied to the donors until cross clamping. Circulatory parameters of the donors did not affect the transplantation outcome measures. Donor dopamine was associated with a significant survival benefit 3 years after heart transplantation [85.7% vs. 65.7%, p=0.02]. Conclusion Preconditioning of brain-dead donors with low-dose dopamine at a dosage of 4μg/kg/min is definitely not harmful for the cardiac allograft but appears to substantially improve patient and graft survival after heart transplantation.

Disclosure: All authors have declared no conflicts of interest.