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Impact of Donor Core Body Temperature on Graft Survival After Heart Transplantation

Schnuelle, Peter, MD1,2; Benck, Urs, MD2; Krämer, Bernhard K., MD2; Yard, Benito A., PhD2; Zuckermann, Andreas, MD3; Wagner, Florian, MD4; Szabo, Gabor, MD5; Borggrefe, Martin, MD6; Karck, Matthias, MD5; Gummert, Jan, MD7

doi: 10.1097/TP.0000000000002337
Original Clinical Science—General

Background A previous donor intervention trial found that induction of mild therapeutic hypothermia in the brain-dead donor reduced the dialysis requirement after kidney transplantation. Consequences on the performance of cardiac allografts after transplantation were not explored to date.

Methods Cohort study investigating 3-year heart allograft survival according to spontaneous core body temperature (CBT) assessed on the day of organ procurement. The study is nested in the database of the randomized trial of donor pretreatment with low-dose dopamine (ClinicalTrials.gov identifier: NCT000115115).

Results Ninety-nine heart transplant recipients who had received a cardiac allograft from a multiorgan donor enrolled in the dopamine trial were grouped by tertiles of the donor's CBT assessed by a mere temperature reading 4 to 20 hours before procurement (lowest, 32.0-36.2°C; middle, 36.3-36.8°C; highest, 36.9-38.8°C). Baseline characteristics considering demographics of donors and recipients, concomitant donor treatments, donor hemodynamic, and respiratory parameters as well as underlying cardiac diseases in recipients, pretransplant hemodynamic assessments, including pretransplant inotropic/mechanical support, urgency, and waiting time were similar. A lower CBT was associated with inferior heart allograft survival (hazard ratio, 0.53; 95% confidence interval, 0.31-0.93, per tertile; P = 0.02, and hazard ratio, 0.68; 95% confidence interval, 0.50-0.93°C; P = 0.02) when CBT was included as continuous explanatory variable in the Cox regression analysis.

Conclusions A lower CBT in the brain-dead donor before procurement may associate with an unfavorable clinical course after heart transplantation. More research is required, before therapeutic hypothermia can routinely be used in multiorgan donors when a cardiac transplantation is intended.

Cohort study investigating 3-year heart allograft survival according to spontaneous core body temperature (CBT) assesses on the day of organ procurement and a lower CBT in the brain-dead donor before procurement may associate with an unfavorable clinical course after heart transplantation.

1 Academic Training Practice, Center for Renal Diseases, Weinheim, Germany.

2 Vth Department of Medicine, University Medical Center Mannheim, Mannheim, Germany.

3 Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.

4 Department of Cardiac Surgery, Asklepios Clinic St. Georg, Hamburg, Germany.

5 Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany.

6 Ist Department of Medicine, University Medical Center Mannheim and German Center for Cardiovascular Research Heidelberg/Mannheim, Mannheim, Germany.

7 Department of Thoracic and Cardiovascular Surgery, Ruhr University Bochum, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany.

Received 9 April 2018. Revision received 23 May 2018.

Accepted 13 June 2018.

The randomized dopamine study was an investigator-driven clinical trial conducted by the University Medical Center Mannheim, Germany. It was partially supported by a medical school grant from Novartis Pharmaceuticals released in November 2002, before the study started recruiting eligible donors.

The authors declare no conflicts of interest.

P.S. and U.B. contributed equally. P.S. drafted the manuscript. P.S., U.B., B.K.K., and B.A.Y. participated in the study concept and design, statistical analysis and interpretation of data. A.Z., F.W., G.S., M.B., M.K., and J.G. participated in the performance of research, acquisition of data, and critical revision of the manuscript for important intellectual content. All authors approved the final version of the manuscript.

Trial registry: ClinicalTrials.gov identifier: NCT000115115

Correspondence: Peter Schnuelle, MD, PhD, Center for Renal Diseases Weinheim, University Medical Center Mannheim, Roentgenstrasse 1, D 69469 Weinheim, Germany. (p.schnuelle@nierenzentrum-weinheim.de).

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