European Heart Journal Advance Access originally published online on March 26, 2009
European Heart Journal 2009 30(14):1771-1780; doi:10.1093/eurheartj/ehp086
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The haemodynamic effects of adjunctive hormone therapy in potential heart donors: a prospective randomized double-blind factorially designed controlled trial
1 Department of Cardiothoracic Surgery, University Hospital Birmingham NHS foundation Trust, Birmingham and University of Birmingham, Edgbaston, Birmingham B15 2TH, UK
2 Department of Cardiology, University Hospital Birmingham NHS foundation Trust, Birmingham and University of Birmingham, Birmingham, UK
3 Department of Medicine, University Hospital Birmingham NHS foundation Trust, Birmingham and University of Birmingham, Birmingham, UK
Received 27 June 2008; revised 28 January 2009; accepted 18 February 2009; online publish-ahead-of-print 26 March 2009.
* Corresponding author. Tel: +44 121 627 2543, Fax: +44 121 627 2542, Email: robert.bonser{at}uhb.nhs.uk
See page 1690 for the editorial comment on this article (doi:10.1093/eurheartj/ehp215)
Aims: The aim of this study was to assess the haemodynamic effects of tri-iodothyronine (T3) and methylprednisolone in potential heart donors.
Methods and results: In a prospective randomized double-blind trial, 80 potential cardiac donors were allocated to receive T3 (0.8 µg kg–1 bolus; 0.113 µg kg–1 h–1 infusion) (n = 20), methylprednisolone (1000 mg bolus) (n = 19), both drugs (n = 20), or placebo (n = 21) following initial haemodynamic assessment. After hormone or placebo administration, cardiac output-guided optimization was initiated, using vasopressin as a pressor and weaning norepinephrine and inotropes. Treatment was administered for 5.9 ± 1.3 h until retrieval or end-assessment. Cardiac index increased significantly (P < 0.001) but administration of T3 and methylprednisolone alone or in combination did not affect this change or the heart retrieval rate. Thirty-five per cent (14/40) of initially marginal or dysfunctional hearts were suitable for transplant at end-assessment. At end-assessment, 50% of donor hearts fulfilled criteria for transplant suitability.
Conclusion: Cardiac output-directed donor optimization improves donor circulatory status and has potential to increase the retrieval rate of donor hearts. Tri-iodothyronine and methylprednisolone therapy do not appear to acutely affect cardiovascular function or yield.
Key Words: Heart transplantation • Hormone replacement therapy • Donor management
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  J. H. Dark More and better donors for cardiac transplantation Eur. Heart J., July 2, 2009; 30(14): 1690 - 1691. [Full Text] [PDF]
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