Donor organ intervention before kidney transplantation

• Verfasst von: Schnülle, Peter [VerfasserIn]
• Verfasst von: Drüschler, Katharina [VerfasserIn]
• Verfasst von: Schmitt, Wilhelm [VerfasserIn]
• Verfasst von: Benck, Urs Tobias [VerfasserIn]
• Verfasst von: Zeier, Martin [VerfasserIn]
• Verfasst von: Krämer, Bernhard [VerfasserIn]
• Verfasst von: Opelz, Gerhard [VerfasserIn]
• Titel: Donor organ intervention before kidney transplantation
• Titelzusatz: Head-to-head comparison of therapeutic hypothermia, machine perfusion, and donor dopamine pretreatment. What is the evidence?
• Verf.angabe: Peter Schnuelle, Katharina Drüschler, Wilhelm H. Schmitt, Urs Benck, Martin Zeier, Bernhard K. Krämer, Gerhard Opelz
• E-Jahr: 2019
• Jahr: [2019]
• Jahr des Originals: 2018
• Umfang: 9 S.
• Fussnoten: First published: 31 July 2018 ; Gesehen am 10.05.2019
• Titel Quelle: Enthalten in: American journal of transplantation
• Ort Quelle: [Amsterdam] : Elsevier, 2001
• Jahr Quelle: 2019
• Band/Heft Quelle: 19(2019), 4, Seite 975-983
• ISSN Quelle: 1600-6143
• DOI: doi:10.1111/ajt.15317
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: clinical research/practice
• Sach-SW: critical care/intensive care management
• Sach-SW: delayed graft function (DGF)
• Sach-SW: donors and donation: deceased
• Sach-SW: kidney (allograft) function/dysfunction
• Sach-SW: organ perfusion and preservation
• Sach-SW: organ procurement and allocation
• Sach-SW: organ transplantation in general
• K10plus-PPN: 1665099747

Abstract

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.