D M Follette1, S M Rudich, W D Babcock. 1. Division of Transplantation, University of California, Davis, School of Medicine, Sacramento 95817, USA.
Abstract
BACKGROUND: The number of patients waiting lung transplantation greatly exceeds the supply of donors. This study was conducted to determine the effect of high-dose steroid administration on oxygenation and donor lung recovery after brain death. METHODS: A retrospective analysis was conducted on 118 consecutive organ donors from January 1 through December 31, 1995. Eighty donors received high-dose steroids (methylprednisolone, mean 14.5+/-0.06 mg/kg) after organ procurement organization management began; a second group was composed of 38 patients who received no steroids. PaO2/FiO2 ratios were used to evaluate oxygenation. The number of single and double lungs transplanted served as the endpoint. RESULTS: No differences were noted in hemodynamics, most clinical or demographic variables and initial values of PaO2/FiO2 between groups. However, nonsteroid-treated donors showed an overall decrease in oxygenation (mean decrease in PaO2/FiO2 -34.2+/-14), whereas steroid-treated donors had a significant and progressive increase in oxygenation (mean increase in PaO2/FiO2: 16+/-14) before aortic cross-clamping (p = 0.01). Time before cross-clamping was longer in the steroid-treated patients (p = 0.003). The number of procured lungs was markedly greater in steroid-treated than nonsteroid-treated donors (25/80 patients vs 3/38; p < 0.01). CONCLUSIONS: High-dose methylprednisolone given during donor management results in improved oxygenation at organ recovery. This treatment resulted in a significant increase in the number of lungs transplanted and may have enabled donors to be treated longer.
BACKGROUND: The number of patients waiting lung transplantation greatly exceeds the supply of donors. This study was conducted to determine the effect of high-dose steroid administration on oxygenation and donor lung recovery after brain death. METHODS: A retrospective analysis was conducted on 118 consecutive organ donors from January 1 through December 31, 1995. Eighty donors received high-dose steroids (methylprednisolone, mean 14.5+/-0.06 mg/kg) after organ procurement organization management began; a second group was composed of 38 patients who received no steroids. PaO2/FiO2 ratios were used to evaluate oxygenation. The number of single and double lungs transplanted served as the endpoint. RESULTS: No differences were noted in hemodynamics, most clinical or demographic variables and initial values of PaO2/FiO2 between groups. However, nonsteroid-treated donors showed an overall decrease in oxygenation (mean decrease in PaO2/FiO2 -34.2+/-14), whereas steroid-treated donors had a significant and progressive increase in oxygenation (mean increase in PaO2/FiO2: 16+/-14) before aortic cross-clamping (p = 0.01). Time before cross-clamping was longer in the steroid-treated patients (p = 0.003). The number of procured lungs was markedly greater in steroid-treated than nonsteroid-treated donors (25/80 patients vs 3/38; p < 0.01). CONCLUSIONS: High-dose methylprednisolone given during donor management results in improved oxygenation at organ recovery. This treatment resulted in a significant increase in the number of lungs transplanted and may have enabled donors to be treated longer.
Authors: Sam D Shemie; Heather Ross; Joe Pagliarello; Andrew J Baker; Paul D Greig; Tracy Brand; Sandra Cockfield; Shaf Keshavjee; Peter Nickerson; Vivek Rao; Cameron Guest; Kimberly Young; Christopher Doig Journal: CMAJ Date: 2006-03-14 Impact factor: 8.262
Authors: Judith E van Zanden; Henri G D Leuvenink; Erik A M Verschuuren; Zwanida J Veldhuis; Petra J Ottens; Michiel E Erasmus; Maximilia C Hottenrott Journal: Transplant Direct Date: 2021-03-16
Authors: Amit Bery; Gary Marklin; Akinobu Itoh; Daniel Kreisel; Tsuyoshi Takahashi; Bryan F Meyers; Ruben Nava; Benjamin D Kozower; Hailey Shepherd; G Alexander Patterson; Varun Puri Journal: Ann Thorac Surg Date: 2021-01-07 Impact factor: 5.102
Authors: Patrick Paulus; Johannes Holfeld; Anja Urbschat; Haitham Mutlak; Pia Alexandra Ockelmann; Sabine Tacke; Kai Zacharowski; Christin Reissig; David Stay; Bertram Scheller Journal: PLoS One Date: 2013-08-29 Impact factor: 3.240