Impact of high-dose inotropic donor support on early myocardial necrosis and outcomes in cardiac transplantation

Authors


  • Conflict of interest: The authors have no conflict of interest to disclose.

Corresponding author: Rami Alharethi, MD, FACC, Heart Failure Prevention and Treatment Program, Intermountain Medical Center, 5121 S. Cottonwood St., Murray, UT 84107, USA.
Tel.: 801 507 4637; fax: 801 507 4811; e-mail: rami.alharethi@imail.org

Abstract

Nixon JL, Kfoury AG, Brunisholz K, Horne BD, Myrick C, Miller DV, Budge D, Bader F, Everitt M, Saidi A, Stehlik J, Schmidt TC, Alharethi R. Impact of high-dose inotropic donor support on early myocardial necrosis and outcomes in cardiac transplantation.
Clin Transplant 2011 DOI: 10.1111/j.1399-0012.2011.01504.x.
© 2011 John Wiley & Sons A/S.

Abstract:  Background:  Cardiac donors routinely require vasoactive agents for circulatory stability after brain death. Nevertheless, inotropes have been associated with direct cardiac toxicity. Our study evaluated whether the use of high-dose inotropic support in potential donors was associated with increased early myocardial necrosis (MN) and worse clinical outcomes after cardiac transplantation.

Methods:  The UTAH Cardiac Transplant Program (UCTP) and Intermountain Donor Services databases were queried for records between 1996 and 2009. The high-dose donor inotropic support (HDIS) group was defined as patients on dopamine >10 μg/kg/min. The incidence of early MN, intensive care unit (ICU) length of stay, length of ventilator support, and mortality was evaluated.

Results:  Two hundred and forty-four recipients undergoing transplant met study criteria. The average donor age was 27 yr. The incidence of MN in the HDIS (n = 29) and non-HDIS (n = 204) groups was 14.8% and 6.7%, respectively, OR 2.67. Total ischemic time, ventilator support time, ICU stay, and actuarial survival were similar between both groups.

Conclusion:  The use of high-dose inotropic support to maintain donor stability appears to have a higher trend for early post-transplant MN without an impact on clinical outcomes. With the current growing shortage of organ donors, it appears reasonable to use donors on high-dose inotropic support.

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