Impact of Donor Core Body Temperature on Graft Survival After Heart Transplantation

Background A previous donor intervention trial found that induction of mild therapeutic hypothermia in the brain-dead donor reduced the dialysis requirement after kidney transplantation. Consequences on the performance of cardiac allografts after transplantation were not explored to date. Methods Cohort study investigating 3-year heart allograft survival according to spontaneous core body temperature (CBT) assessed on the day of organ procurement. The study is nested in the database of the randomized trial of donor pretreatment with low-dose dopamine (ClinicalTrials.gov identifier: NCT000115115). Results 99 heart transplant recipients who had received a cardiac allograft from a multiorgan donor enrolled in the dopamine trial were grouped by tertiles of the donor's CBT assessed by a mere temperature reading 4-20 hours before procurement (lowest, 32.0-36.2°C; middle, 36.3-36.8°C; highest, 36.9-38.8°C). Baseline characteristics considering demographics of donors and recipients, concomitant donor treatments, donor hemodynamic and respiratory parameters as well as underlying cardiac diseases in recipients, pretransplant hemodynamic assessments, including pretransplant inotropic / mechanical support, urgency, and waiting-time were similar. A lower CBT was associated with inferior heart allograft survival, hazard ratio (HR) 0.53, 95% confidence interval (CI) 0.31-0.93, per tertile; p=0.02, and HR 0.68, 95% CI 0.50-0.93, per degree Celsius; p=0.02, when CBT was included as continuous explanatory variable in the Cox regression analysis. Conclusions A lower CBT in the brain-dead donor before procurement may associate with an unfavorable clinical course after heart transplantation. More research is required, before therapeutic hypothermia can routinely be used in multiorgan donors when a cardiac transplantation is intended. Address correspondence to: Dr. Peter Schnuelle, Center for Renal Diseases Weinheim, c/o University Medical Center Mannheim, Roentgenstrasse 1, D 69469 Weinheim, Germany, Tel.: 0049 6201 947931, Fax: 0049 6201 947920, e-mail: p.schnuelle@nierenzentrum-weinheim.de Authorship P.S. and U.B. contributed equally. P.S. drafted the manuscript. P.S., U.B., B.K.K., B.A.Y. participated in the study concept and design, statistical analysis and interpretation of data. A.Z., F.W., G.S., M.B., M.K., J.G. participated in the performance of research, acquisition of data, and critical revision of the manuscript for important intellectual content. All authors approved the final version of the manuscript. Disclosure The authors declare no conflicts of interest. Funding The randomized dopamine study was an investigator-driven clinical trial conducted by the University Medical Center Mannheim, Germany. It was partially supported by a medical school grant from Novartis Pharmaceuticals released in November 2002, before the study started recruiting eligible donors. Trial registry ClinicalTrials.gov identifier: NCT000115115 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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