Early hormonal therapy stabilizes hemodynamics during donor procurement

• Published in: Transplantation proceedings Vol. 36; no. 9; pp. 2573 - 2578
• Main Authors: Van Bakel, A.B., Pitzer, S., Drake, P., Kay, N.A., Stroud, M., Sade, R.M.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-11-2004; Elsevier Science
• Subjects: Biological and medical sciences; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hemodynamics; Hormones - therapeutic use; Hormones. Endocrine system; Humans; Medical sciences; Pharmacology. Drug treatments; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue and Organ Harvesting - methods; Tissue and Organ Procurement - methods; Tissue Donors; Tissue, organ and graft immunology; Human; Medicine; Stability; Donor; Hormone therapy; Surgery; Graft; Early; Transplantation; Hemodynamics; Physicochemical properties
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2004.10.016

Hemodynamic instability has been implicated in the loss of otherwise
transplantable organs. We examined the hypothesis that administration of hormonal therapy early
during donor management would stabilize hemodynamics and increase the number of organs
procured.
We retrospectively analyzed 133 consecutive donor records from a single organ
procurement organization. Controls (C) received no early hormonal therapy. A steroid group (S)
received methylprednisolone only and a combination hormonal therapy group (CH) received
thyroxine, methylprednisolone, dextrose, and insulin at the start of donor management (t
0h).
Adrenergic support was adjusted to maintain mean arterial blood pressure (MAP) at ≥60 mm Hg. Doses of adrenergic agents were
assessed at t
0h, 4 hours (t
4h), and just prior to procurement (t
proc).
Baseline characteristics were similar in all groups. Dosages of adrenergic agents
decreased over time in all groups. A significant decrease in adrenergic requirements was seen in
the CH group compared with the C group at t
4h and t
proc. A trend toward decreased adrenergic requirements
was noted in S compared with C at t
4h and t
proc. Slightly more total organs were procured from S
and CH compared with C.
Significantly less adrenergic support was required with early use of CH. A similar
(although nonsignificant) reduction was seen with S. The benefit(s) of CH vs corticosteroids alone
remains uncertain and requires further study.