Donor Dopamine Improves Transplant Outcomes
Pretreatment of brain-dead kidney donors with dopamine significantly decreases the likelihood that those who receive their kidneys will require multiple dialysis sessions within a week after transplantation, new findings suggest.
Peter Schnuelle, MD, PhD, of the University Medical Centre Mannheim, Germany, and colleagues studied 264 deceased heart-beating donors and 487 subsequent kidney transplants performed at 60 European centers from March 2004 to August 2007. The investigators randomly assigned 124 donors to receive low-dose dopamine and 140 not to receive the drug. For dopamine recipients, the median dopamine infusion time was 344 minutes.
Dr. Schnuelle's team found that fewer kidney recipients whose donor had received dopamine (24.7%) needed multiple dialyses compared with the recipients in the nondopamine group (35.4%).
Additionally, the need for multiple dialyses post-transplant was associated with a 3.6 times increased risk of allograft failure after three years, whereas a single dialysis was not associated with an increase risk.
The investigators found that the effect of dopamine was particularly enhanced in the subgroup of kidneys transplanted after a mean cold ischemia time of 21.2 hours. In this group, donor dopamine translated into improved long-term graft survival, which was 90.5% in the dopamine group and 73.5% in the nondopamine group.
When both kidneys of each donor were transplanted, pretreatment of 10 donors prevented the need for multiple dialyses in two renal transplant patients, the researchers reported in the Journal of the American Medical Association (2009;302:1067-1075).
As Dr. Schnuelle and his team observed: “The majority of kidneys transplanted worldwide are retrieved from deceased heart-beating donors. As a consequence of brain death, the kidney graft is exposed to numerous injurious events prior to transplantation that predispose it to functional impairment after transplantation.”
The researchers concluded that dopamine can directly interact with the cell membrane and, when administered in relevant concentrations to a brain-dead donor, can protect endothelial cells from oxidative stress during cold storage. This in turn reduces the need for kidney recipients to undergo dialysis in order to restore renal function.
In addition, the researchers found that multiple dialyses increases the risk of graft failure in the long-term, but a single dialysis post-transplant does not.
The most common side effects of the drug before renal function returned include significant but clinically meaningless increases in the donor's systolic BP and urine production, the authors noted. However, these side effects had no influence on the outcome, they concluded.