• Peter Schnuelle, Uwe Gottmann, Simone Hoeger, Detlef Boesebeck, Werner Lauchart, Christel Weiss, Michael Fischereder, Karl-Walter Jauch, Uwe Heemann, Martin Zeier, Christian Hugo, Przemyslaw Pisarski, Bernhard K Krämer, Kai Lopau, Axel Rahmel, Urs Benck, Rainer Birck, and Benito Antonio Yard.
• University Medical Centre Mannheim, 5th Department of Medicine, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany. peter.schnuelle@med5.ma.uni-heidelberg.de
• JAMA. 2009 Sep 9; 302 (10): 1067-75.

ContextKidney graft function after transplantation can be improved through pharmacological donor pretreatment to limit organ injury from cold preservation.ObjectiveTo determine whether pretreatment of brain-dead donors with low-dose dopamine improves early graft function in human renal transplant recipients.Design, Setting, And PatientsRandomized, open-label, multicenter, parallel-group trial of 264 deceased heart-beating donors and 487 subsequent renal transplants performed at 60 European centers between March 2004 and August 2007 (final follow-up, December 31, 2008). Eligible donors were stable under low-dose norepinephrine with a normal serum creatinine concentration on admission.InterventionsDonors were randomized to receive low-dose dopamine (4 mug/kg/min).Main Outcome MeasuresDialysis requirement during first week after transplantation.ResultsDopamine was infused for a median of 344 minutes (IQR, 215 minutes). Dialysis was significantly reduced in recipients of a dopamine-treated graft. Fewer recipients in the treatment group needed multiple dialyses (56/227; 24.7%; 95% CI, 19.0%-30.3%; vs 92/260; 35.4%; 95% CI, 29.5%-41.2%; P = .01). The need for multiple dialyses posttransplant was associated with allograft failure after 3 years (HR, 3.61; 95% CI, 2.39-5.45; P < .001), whereas a single dialysis was not (HR, 0.67; 95% CI, 0.21-2.18; P = .51). Besides donor dopamine (OR, 0.54; 95% CI, 0.35-0.83; P = .005), cold ischemic time (OR, 1.07; 95% CI, 1.02-1.11 per hour; P = .001), donor age (OR, 1.03; 95% CI, 1.01-1.05 per year; P < .001), and recipient body weight (OR, 1.02; 95% CI, 1.01-1.04 per kg; P = .009) were independent explanatory variables in a multiple logistic regression model. Dopamine resulted in significant but clinically meaningless increases in the donor's systolic blood pressure (3.8 mm Hg; 95% CI, 0.7-6.9 mm Hg; P = .02) and urine production before surgical recovery of the kidneys (29 mL; 95% CI, 7-51 mL; P = .009) but had no influence on outcome.ConclusionDonor pretreatment with low-dose dopamine reduces the need for dialysis after kidney transplantation.Trial Registrationclinicaltrials.gov Identifier: NCT00115115.

23 keywords...

hide…