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 mug/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.
RCT Entities:
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 mug/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 donordopamine (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.
Authors: Michael M Rey; Lorraine B Ware; Michael A Matthay; Gordon R Bernard; Amy L McGuire; Arthur L Caplan; Scott D Halpern Journal: Crit Care Med Date: 2011-02 Impact factor: 7.598
Authors: Peter Schnuelle; Wilhelm H Schmitt; Christel Weiss; Antje Habicht; Lutz Renders; Martin Zeier; Felix Drüschler; Katharina Heller; Przemyslaw Pisarski; Bernhard Banas; Bernhard K Krämer; Matthias Jung; Kai Lopau; Christoph J Olbricht; Horst Weihprecht; Peter Schenker; Johan W De Fijter; Benito A Yard; Urs Benck Journal: Clin J Am Soc Nephrol Date: 2017-02-17 Impact factor: 8.237
Authors: Sebastian Giwa; Jedediah K Lewis; Luis Alvarez; Robert Langer; Alvin E Roth; George M Church; James F Markmann; David H Sachs; Anil Chandraker; Jason A Wertheim; Martine Rothblatt; Edward S Boyden; Elling Eidbo; W P Andrew Lee; Bohdan Pomahac; Gerald Brandacher; David M Weinstock; Gloria Elliott; David Nelson; Jason P Acker; Korkut Uygun; Boris Schmalz; Brad P Weegman; Alessandro Tocchio; Greg M Fahy; Kenneth B Storey; Boris Rubinsky; John Bischof; Janet A W Elliott; Teresa K Woodruff; G John Morris; Utkan Demirci; Kelvin G M Brockbank; Erik J Woods; Robert N Ben; John G Baust; Dayong Gao; Barry Fuller; Yoed Rabin; David C Kravitz; Michael J Taylor; Mehmet Toner Journal: Nat Biotechnol Date: 2017-06-07 Impact factor: 54.908
Authors: Ralf M Lösel; Ulf Schnetzke; Paul T Brinkkoetter; Hui Song; Grietje Beck; Peter Schnuelle; Simone Höger; Martin Wehling; Benito A Yard Journal: PLoS One Date: 2010-03-16 Impact factor: 3.240