Early hormonal therapy stabilizes hemodynamics during donor procurement

Abstract 

Background

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.

Methods

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).

Results

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.

Conclusions

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.