Beneficial outcome using thyroid and other hormones in heart
transplantation. See below..
Greg
<QUOTE>
1: Transplantation 2003 Apr 27;75(8):1336-41
Hormonal resuscitation yields more transplanted hearts, with improved early
function.
Rosendale JD, Kauffman HM, McBride MA, Chabalewski FL, Zaroff JG, Garrity
ER,
Delmonico FL, Rosengard BR.
2 Research Department, United Network for Organ Sharing, Richmond, VA. 8
Address
correspondence to: John D. Rosendale, M.S., United Network for Organ
Sharing,
700 North 4th Street, Richmond, VA 23219.
BACKGROUNDBrain death results in cardiovascular instability and poor organ
perfusion in many brain-dead donors. Hormonal resuscitation stabilizes
certain
brain-dead donors and is associated with significant increases in the
numbers of
organs transplanted per donor. The goal of this study was to examine the
quality
of hearts recovered from donors treated with hormonal resuscitation.METHODSA
retrospective analysis of 4,543 recipients of hearts recovered from
brain-dead
donors, reported to the United Network for Organ Sharing/Organ Procurement
and
Transplantation Network database between November 1, 1999, and December 31,
2001, was conducted. Hormonal resuscitation consisted of a
methylprednisolone
bolus and infusions of vasopressin and either triiodothyronine or
l-thyroxine.
Univariate and multivariate analyses were used to evaluate the quality of
hearts
from donors who received three-drug hormonal resuscitation (3HR) treatment
versus donors who did not receive all three drugs (non-3HR). Death within 30
days and early graft dysfunction were used as endpoints.RESULTSHearts from
3HR
donors demonstrated a 1-month survival rate of 96.2%, compared with a 92.1%
survival rate for non-3HR donor hearts (P<0.01). Early graft dysfunction
occurred in 5.6% of 3HR donor hearts and 11.6% of non-3HR donor hearts
(P<0.01).
Multivariate results demonstrated a 46% reduced odds of death within 30 days
and
a 48% reduced odds of early graft dysfunction. Steroids alone and steroids
plus
triiodothyronine/l-thyroxine also significantly reduced prolonged graft
dysfunction.CONCLUSIONSThis study suggests that 3HR treatment of brain-dead
donors results in increased numbers of transplanted hearts, with improved
short-term graft function.
PMID: 12717226 [PubMed - in process]
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