Administering dopamine to brain-dead kidney donor may improve outcome of transplant

Pretreatment of a brain-dead, heart-beating kidney donor with dopamine reduced the need for dialysis for the kidney recipient in the first week after the transplantation, according to a study in the 9 September issue of JAMA.

"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," according to background information provided by the authors. While limiting organ injury through medical donor management may have an effect on the transplantation outcome, current recommendations are based on limited evidence from observational studies only.

Peter Schnuelle, MD, PhD, of the University Medical Centre Mannheim, Germany, and colleagues assessed the effectiveness of donor pretreatment with dopamine by measuring the postoperative incidence of dialyses in kidney transplant recipients who received a kidney graft from a brain-dead donor. The trial included 264 deceased heart-beating donors and 487 subsequent kidney transplants performed at 60 European centres between March 2004 and August 2007, with final follow-up through December 2008. Donors were randomised to receive low-dose dopamine, which was infused for a median (midpoint) of 344 minutes.

The researchers found that donor dopamine treatment resulted in a significantly reduced use of dialysis after transplantation. Fewer recipients in the treatment group (24.7 percent) needed multiple dialyses before renal function recovered than did recipients in the nondopamine group (35.4 percent). "Accordingly, when both kidneys of each donor were transplanted, pretreatment of 10 donors prevented the need for multiple dialyses in 2 renal transplant recipients," the researchers write.

The data also indicated that multiple dialyses increased the chances of graft failure in the long-term, whereas a single dialysis posttransplant did not.

"Dopamine resulted in significant but clinically meaningless increases in the donor’s systolic blood pressure and urine production before surgical recovery of the kidneys but had no influence on outcome," the authors note.

"In conclusion, this study shows that pretreatment of the deceased heart-beating donor with low-dose dopamine reduces the need for dialysis in the recipient after kidney transplantation."

(Source: JAMA/Archives: JAMA: September 2009)