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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...

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Main Authors: Schnülle, Peter (Author) , Drüschler, Katharina (Author) , Schmitt, Wilhelm (Author) , Benck, Urs Tobias (Author) , Zeier, Martin (Author) , Krämer, Bernhard (Author) , Opelz, Gerhard (Author)
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
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Author Notes:Peter Schnuelle, Katharina Drüschler, Wilhelm H. Schmitt, Urs Benck, Martin Zeier, Bernhard K. Krämer, Gerhard Opelz

MARC

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520 |a 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. 
534 |c 2018 
650 4 |a clinical research/practice 
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650 4 |a delayed graft function (DGF) 
650 4 |a donors and donation: deceased 
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650 4 |a organ perfusion and preservation 
650 4 |a organ procurement and allocation 
650 4 |a organ transplantation in general 
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