Impact of high‐dose inotropic donor support on early myocardial necrosis and outcomes in cardiac transplantation
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. 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. 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. 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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- [Show abstract] [Hide abstract] ABSTRACT: Increased incidence of myocardial infarction (MI) associated with the use of hemoglobin based oxygen carriers (HBOCs) is a concern arising from the clinical evaluation of these formulations. Many characteristics of HBOCs may affect cardiac performance, as will specifics of treatment protocols. The vasoactivity of HBOCs affects the hemodynamic response to their infusion, but tissue oxygenation and blood flow to the heart is maintained or enhanced in a variety of circumstances, even when cardiac output is decreased. HBOC infusions are protective in several preclinical models of cardiac ischemia/reperfusion injury and supportive or restorative of cardiac function in models of hemodilution and resuscitation from hemorrhagic shock. Microscopic cardiac lesions observed during the preclinical testing of some HBOCs are a consequence of nitric oxide scavenging, but this mechanism is unlikely to be clinically significant unless humans are unusually sensitive. Understanding the reason(s) for the observed clinical imbalance in MI is hampered by the lack of detailed information concerning the physiologic and biochemical responses of the human cardiovascular system to HBOC infusion and appreciation for the degree to which suboptimal patient management in the presence of these unique solutions has contributed to the observed results.0Comments 0Citations