Routine hormonal therapy in the heart transplant donor

• Published in: Cirugia y cirujanos Vol. 84; no. 3; p. 230
• Main Authors: Zetina-Tun, Hugo, Lezama-Urtecho, Carlos, Careaga-Reyna, Guillermo
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.05.2016
• Subjects: Adolescent; Adult; Brain Death; Female; Heart - drug effects; Heart Transplantation; Humans; Infusions, Intravenous; Intubation, Gastrointestinal; Male; Methylprednisolone - administration & dosage; Methylprednisolone - pharmacology; Middle Aged; Postoperative Complications - mortality; Prospective Studies; Stroke Volume; Thyroxine - administration & dosage; Thyroxine - pharmacology; Tissue and Organ Harvesting - methods; Tissue Donors; Young Adult; Hormonal rescue; Levothyroxine; Donador; Donor; Rescate hormonal; Levotiroxina; Cardiac transplantation; Trasplante cardiaco
• ISSN: 0009-7411
• DOI: 10.1016/j.circir.2015.01.003

Successful heart transplantation depends largely on donor heart function. During brain death many hormonal changes occur. These events lead to the deterioration of the donor hearts. The 2002 Crystal Consensus advises the use of a triple hormonal scheme to rescue marginal cardiac organs. A prospective, longitudinal study was conducted on potential donor hearts during the period 1 July 2011 to 31 May 2013. All donor hearts received a dual hormonal rescue scheme, with methylprednisolone 15mg/kg IV and 200mcg levothyroxine by the enteral route. There was at least a 4 hour wait prior to the harvesting. The preload and afterload was optimised. The variables measured were: left ventricular ejection fraction cardiac graft recipient; immediate and delayed mortality. A total of 30 orthotopic heart transplants were performed, 11 female and 19 male patients, with age range between 19 and 63 years-old (Mean: 44.3, SD 12.92 years). The donor hearts were 7 female and 23 male, with age range between 15 and 45 years-old (mean 22.5, SD 7.3 years). Immediate mortality was 3.3%, 3.3% intermediate, and delayed 3.3%, with total 30 day-mortality of 10%. Month survival was 90%. The immediate graft left ventricular ejection fraction was 45%, 60% intermediate, and 68% delayed. The causes of death were: 1 primary graft dysfunction, one massive pulmonary embolism, and one due to nosocomial pneumonia. It was concluded that the use of double rescue scheme hormonal therapy is useful for the recovery and preservation of the donor hearts. This scheme improves survival within the first 30 days after transplantation.