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Effects of Donor Pretreatment With Dopamine on Graft Function After Kidney TransplantationA Randomized Controlled Trial
Peter Schnuelle, MD, PhD;
Uwe Gottmann, MD;
Simone Hoeger, PhD;
Detlef Boesebeck, MD;
Werner Lauchart, MD, PhD;
Christel Weiss, PhD;
Michael Fischereder, MD, PhD;
Karl-Walter Jauch, MD, PhD;
Uwe Heemann, MD, PhD;
Martin Zeier, MD, PhD;
Christian Hugo, MD, PhD;
Przemyslaw Pisarski, MD;
Bernhard K. Krämer, MD, PhD;
Kai Lopau, MD;
Axel Rahmel, MD, PhD;
Urs Benck, MD;
Rainer Birck, MD, PhD;
Benito Antonio Yard, PhD
JAMA. 2009;302(10):1067-1075.
Context Kidney graft function after transplantation can be improved through pharmacological donor pretreatment to limit organ injury from cold preservation.
Objective To determine whether pretreatment of brain-dead donors with low-dose dopamine improves early graft function in human renal transplant recipients.
Design, Setting, and Patients Randomized, open-label, multicenter, parallel-group trial of 264 deceased heart-beating donors and 487 subsequent renal transplants performed at 60 European centers between March 2004 and August 2007 (final follow-up, December 31, 2008). Eligible donors were stable under low-dose norepinephrine with a normal serum creatinine concentration on admission.
Interventions Donors were randomized to receive low-dose dopamine (4 µg/kg/min).
Main Outcome Measures Dialysis requirement during first week after transplantation.
Results Dopamine was infused for a median of 344 minutes (IQR, 215 minutes). Dialysis was significantly reduced in recipients of a dopamine-treated graft. Fewer recipients in the treatment group needed multiple dialyses (56/227; 24.7%; 95% CI, 19.0%-30.3%; vs 92/260; 35.4%; 95% CI, 29.5%-41.2%; P = .01). The need for multiple dialyses posttransplant was associated with allograft failure after 3 years (HR, 3.61; 95% CI, 2.39-5.45; P < .001), whereas a single dialysis was not (HR, 0.67; 95% CI, 0.21-2.18; P = .51). Besides donor dopamine (OR, 0.54; 95% CI, 0.35-0.83; P = .005), cold ischemic time (OR, 1.07; 95% CI, 1.02-1.11 per hour; P = .001), donor age (OR, 1.03; 95% CI, 1.01-1.05 per year; P < .001), and recipient body weight (OR, 1.02; 95% CI, 1.01-1.04 per kg; P = .009) were independent explanatory variables in a multiple logistic regression model. Dopamine resulted in significant but clinically meaningless increases in the donor's systolic blood pressure (3.8 mm Hg; 95% CI, 0.7-6.9 mm Hg; P = .02) and urine production before surgical recovery of the kidneys (29 mL; 95% CI, 7-51 mL; P = .009) but had no influence on outcome.
Conclusion Donor pretreatment with low-dose dopamine reduces the need for dialysis after kidney transplantation.
Trial Registration clinicaltrials.gov Identifier: NCT00115115
Author Affiliations: University Medical Centre Mannheim, Mannheim, Germany (Drs Schnuelle, Gottmann, Hoeger, Benck, Birck, and Yard); Organ Procurement Organization of Bavaria, Munich, Germany (Dr Boesebeck); Organ Procurement Organization of Baden-Württemberg, Stuttgart, Germany (Dr Lauchart); Department of Biomathematics and Medical Statistics, Mannheim (Dr Weiss); Klinikum Innenstadt, Ludwig Maximilians University of Munich, Munich (Dr Fischereder); Klinikum Großhadern, Department of Surgery, Ludwig Maximilians University of Munich (Dr Jauch); Klinikum Rechts der Isar, Technical University of Munich, Munich (Dr Heemann); University Hospital Heidelberg, Heidelberg, Germany (Dr Zeier); University Hospital Erlangen, Erlangen, Germany (Dr Hugo); University Hospital Freiburg, Freiburg, Germany (Dr Pisarski); Marienhospital Herne, University Hospital Bochum, Bochum, Germany (Dr Krämer); University Hospital Würzburg, Würzburg, Germany (Dr Lopau); and Eurotransplant International Foundation, Leiden, the Netherlands (Dr Rahmel).
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BMJ 2009;339:b3739-b3739.
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