Effects of Donor Pretreatment With Dopamine on Graft Function After Kidney Transplantation
A 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
- 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).
Abstract
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
