Donor organ intervention before kidney transplantation: Head-to-head comparison of therapeutic hypothermia, machine perfusion, and donor dopamine pretreatment. What is the evidence?
Therapeutic hypothermia, hypothermic pulsatile machine perfusion (MP), and renal-dose dopamine administered to stable brain-dead donors have shown efficacy to reduce the dialysis requirement after kidney transplantation. In a head-to-head comparison of the three major randomized controlled trials in...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article (Journal) |
| Language: | English |
| Published: |
[2019]
|
| In: |
American journal of transplantation
Year: 2018, Volume: 19, Issue: 4, Pages: 975-983 |
| ISSN: | 1600-6143 |
| DOI: | 10.1111/ajt.15317 |
| Online Access: | Verlag, Volltext: https://doi.org/10.1111/ajt.15317 Verlag, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1111/ajt.15317 
|
| Author Notes: | Peter Schnuelle, Katharina Drüschler, Wilhelm H. Schmitt, Urs Benck, Martin Zeier, Bernhard K. Krämer, Gerhard Opelz |
| Summary: | Therapeutic hypothermia, hypothermic pulsatile machine perfusion (MP), and renal-dose dopamine administered to stable brain-dead donors have shown efficacy to reduce the dialysis requirement after kidney transplantation. In a head-to-head comparison of the three major randomized controlled trials in this field, we estimated the number-needed-to-treat for each method, evaluated costs and inquired into special features regarding long-term outcomes. The MP and hypothermia trials used any dialysis requirement during the first postoperative week, whereas the dopamine trial assessed >1 dialysis session as primary endpoint. Compared to controls, the respective rates declined by 5.7% with MP, 10.9% with hypothermia, and 10.7% with dopamine. Costs to prevent one endpoint in one recipient amount to approximately $17 000 with MP but are negligible with the donor interventions. MP resulted in a borderline significant difference of 4% in 3-year graft survival, but a point of interest is that the preservation method was switched in 25 donors (4.6%) for technical reasons. Graft survival was not improved with dopamine on intention-to-treat but suggested an exposure-response relationship with infusion time. MP was less efficacious and cost-effective to prevent posttransplant dialysis. Whether the benefit on early graft dysfunction achieved with any method will improve long-term graft survival remains to be established. |
|---|---|
| Item Description: | First published: 31 July 2018 Gesehen am 10.05.2019 |
| Physical Description: | Online Resource |
| ISSN: | 1600-6143 |
| DOI: | 10.1111/ajt.15317 |