Early hormonal therapy stabilizes hemodynamics during donor procurement

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. 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). 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. 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.