Donor Noradrenaline Support Is Not Associated with Decreased Survival in Heart Transplant Recipients
Objective: Although the application of higher doses of norepinephrine (NE) in potential organ donors is a frequent reason for heart decline, its associations with outcomes after heart transplantation (HTx) are discussed controversially. Therefore, we aimed to explore donor NE support’s potential imp...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-12-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/24/7271 |
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| author | Daniel Oehler Charlotte Böttger Moritz Benjamin Immohr Raphael Romano Bruno Jafer Haschemi Daniel Scheiber Fabian Voß Patrick Horn Hug Aubin Igor Tudorache Ralf Westenfeld Payam Akhyari Malte Kelm Artur Lichtenberg Udo Boeken |
| author_facet | Daniel Oehler Charlotte Böttger Moritz Benjamin Immohr Raphael Romano Bruno Jafer Haschemi Daniel Scheiber Fabian Voß Patrick Horn Hug Aubin Igor Tudorache Ralf Westenfeld Payam Akhyari Malte Kelm Artur Lichtenberg Udo Boeken |
| author_sort | Daniel Oehler |
| collection | DOAJ |
| description | Objective: Although the application of higher doses of norepinephrine (NE) in potential organ donors is a frequent reason for heart decline, its associations with outcomes after heart transplantation (HTx) are discussed controversially. Therefore, we aimed to explore donor NE support’s potential impact on outcomes in our single-center heart transplant cohort. Methods: All patients who had undergone HTx in our center between September 2010 and April 2022 (<i>n</i> = 241) were screened for eligibility. From those, all patients with complete data on donor NE support (<i>n</i> = 238) were included. Recipients were divided into three groups according to their donor NE support: without support (<i>n</i> = 26), with low support of 0.01–0.2 µg/kg/min (<i>n</i> = 132), and with high support of > 0.2 µg/kg/min (<i>n</i> = 80). Receiver operating characteristics (ROC) and Kaplan Meier analysis was used to investigate the association of donor NE support and mortality after heart transplantation. Recipient and donor variables, including peri- and postoperative characteristics, were reviewed and compared. Results: NE support in donors ranged between 0 and 2.94 µg/kg/min (median 0.13 µg/kg/min, IQR 0.05–0.26 µg/kg/min). No association between donor NE support and mortality after HTx was observed (AUC for overall survival 0.494). Neither Kaplan-Meier analysis in survival up to 5 years after transplantation (Log Rank <i>p</i> = 0.284) nor group comparisons showed significant differences between the groups. With few exceptions, baseline characteristics in recipients and donors were comparable between the groups. Regarding peri- and postoperative parameters, increasing donor NE support was associated with a longer duration of mechanical ventilation (68 h and 95 h vs. 47 h), longer postoperative IMC/ICU stay (14 vs. 15 vs. 19 days), and a higher need for mechanical life support post-HTx (26% and 39% vs. 12%). Conclusion: In this retrospective analysis, NE support in donors prior to heart transplantation was unrelated to differing survival after heart transplantation. However, higher doses of donor NE were associated with prolonged ventilation, longer duration on IMC/ICU, and a higher need for extracorporeal life support in recipients post-HTx. |
| first_indexed | 2024-03-09T16:17:16Z |
| format | Article |
| id | doaj.art-e603016a07ca4b1ea30b50fd1d213cf2 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T16:17:16Z |
| publishDate | 2022-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-e603016a07ca4b1ea30b50fd1d213cf22023-11-24T15:42:39ZengMDPI AGJournal of Clinical Medicine2077-03832022-12-011124727110.3390/jcm11247271Donor Noradrenaline Support Is Not Associated with Decreased Survival in Heart Transplant RecipientsDaniel Oehler0Charlotte Böttger1Moritz Benjamin Immohr2Raphael Romano Bruno3Jafer Haschemi4Daniel Scheiber5Fabian Voß6Patrick Horn7Hug Aubin8Igor Tudorache9Ralf Westenfeld10Payam Akhyari11Malte Kelm12Artur Lichtenberg13Udo Boeken14Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, GermanyDepartment of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, GermanyDepartment of Cardiac Surgery, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, GermanyDepartment of Cardiac Surgery, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, GermanyDepartment of Cardiac Surgery, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, GermanyDepartment of Cardiac Surgery, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, GermanyDepartment of Cardiac Surgery, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, GermanyDepartment of Cardiac Surgery, Medical Faculty, Heinrich-Heine University, 40225 Düsseldorf, GermanyObjective: Although the application of higher doses of norepinephrine (NE) in potential organ donors is a frequent reason for heart decline, its associations with outcomes after heart transplantation (HTx) are discussed controversially. Therefore, we aimed to explore donor NE support’s potential impact on outcomes in our single-center heart transplant cohort. Methods: All patients who had undergone HTx in our center between September 2010 and April 2022 (<i>n</i> = 241) were screened for eligibility. From those, all patients with complete data on donor NE support (<i>n</i> = 238) were included. Recipients were divided into three groups according to their donor NE support: without support (<i>n</i> = 26), with low support of 0.01–0.2 µg/kg/min (<i>n</i> = 132), and with high support of > 0.2 µg/kg/min (<i>n</i> = 80). Receiver operating characteristics (ROC) and Kaplan Meier analysis was used to investigate the association of donor NE support and mortality after heart transplantation. Recipient and donor variables, including peri- and postoperative characteristics, were reviewed and compared. Results: NE support in donors ranged between 0 and 2.94 µg/kg/min (median 0.13 µg/kg/min, IQR 0.05–0.26 µg/kg/min). No association between donor NE support and mortality after HTx was observed (AUC for overall survival 0.494). Neither Kaplan-Meier analysis in survival up to 5 years after transplantation (Log Rank <i>p</i> = 0.284) nor group comparisons showed significant differences between the groups. With few exceptions, baseline characteristics in recipients and donors were comparable between the groups. Regarding peri- and postoperative parameters, increasing donor NE support was associated with a longer duration of mechanical ventilation (68 h and 95 h vs. 47 h), longer postoperative IMC/ICU stay (14 vs. 15 vs. 19 days), and a higher need for mechanical life support post-HTx (26% and 39% vs. 12%). Conclusion: In this retrospective analysis, NE support in donors prior to heart transplantation was unrelated to differing survival after heart transplantation. However, higher doses of donor NE were associated with prolonged ventilation, longer duration on IMC/ICU, and a higher need for extracorporeal life support in recipients post-HTx.https://www.mdpi.com/2077-0383/11/24/7271donor noradrenaline supportshort-term survivalheart transplantation |
| spellingShingle | Daniel Oehler Charlotte Böttger Moritz Benjamin Immohr Raphael Romano Bruno Jafer Haschemi Daniel Scheiber Fabian Voß Patrick Horn Hug Aubin Igor Tudorache Ralf Westenfeld Payam Akhyari Malte Kelm Artur Lichtenberg Udo Boeken Donor Noradrenaline Support Is Not Associated with Decreased Survival in Heart Transplant Recipients Journal of Clinical Medicine donor noradrenaline support short-term survival heart transplantation |
| title | Donor Noradrenaline Support Is Not Associated with Decreased Survival in Heart Transplant Recipients |
| title_full | Donor Noradrenaline Support Is Not Associated with Decreased Survival in Heart Transplant Recipients |
| title_fullStr | Donor Noradrenaline Support Is Not Associated with Decreased Survival in Heart Transplant Recipients |
| title_full_unstemmed | Donor Noradrenaline Support Is Not Associated with Decreased Survival in Heart Transplant Recipients |
| title_short | Donor Noradrenaline Support Is Not Associated with Decreased Survival in Heart Transplant Recipients |
| title_sort | donor noradrenaline support is not associated with decreased survival in heart transplant recipients |
| topic | donor noradrenaline support short-term survival heart transplantation |
| url | https://www.mdpi.com/2077-0383/11/24/7271 |
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