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24 June 2013

Norepinephrine versus dopamine pretreatment of potential heart donors – impact on long-term outcome

Franz von ZieglerACE, Susanne HelbigB, Nicole KreisslB, Bruno MeiserE, Alexander BeckerCE, Ingo KaczmarekAE

DOI: 10.12659/AOT.883960

Ann Transplant 2013; 18:320-326

Abstract

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.

Keywords: Heart Transplantation, survival rate , donor pre-treatment, Norepinephrine, Dopamine

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358