Donor Desmopressin Is Associated With Superior Graft Survival After Kidney Transplantation

• DOI: 10.1097/tp.0b013e318236cd4c
• Publication Date: 2011-11-08T09:47:29Z
• Authors: Urs Benck; Uwe Gottmann; Simone Hoeger; Alexander Lammert; Daniela Rose; Detlef Boesebeck; Werner Lauchart; Rainer Birck; Christel Weiss; Bernhard K. Krämer; Benito A. Yard; Peter Schnuelle
• Keywords: Desmopressin

A recent randomized trial showed that pretreatment of the brain-dead donor with low-dose dopamine improves immediate kidney graft function, by limiting injury from cold storage (ClinicalTrials.gov Identifier: NCT00115115). This study determines whether exposure to desmopressin (1-deamino-8-d-arginine-vasopressin [DDAVP]) before organ retrieval affects renal transplant outcome.This retrospective multicenter cohort study, nested in database trial, includes 264 deceased heart-beating donors confirmed brain death and corresponding 487 allograft recipients transplanted at 60 European centers between March 2004 August 2007. We assessed differences delayed biopsy-proven acute rejections, 2-year survival a DDAVP-exposed versus unexposed graft.DDAVP was associated improved (85.4% vs. 73.6%, P=0.003). benefit persisted after censoring for functioning (91.1% 82.0%, P=0.01) adjustment confounders including covariate propensity scoring (hazard ratio 0.40, 95% confidence interval [CI] 0.21-0.77; P=0.006). Delayed function (odds 0.97, CI 0.57-1.65; P=0.92) rejections 1.32, 0.70-2.49; P=0.40) were unaffected. The effect enhanced shorter ischemic time less than 14 hr (91.3% 77.8%, P=0.008) (92.7% 78.6%, By contrast, prolonged more or equal (91.2% 86.5%, P=0.39) assignment nondopamine group (89.7% 84.8%, P=0.37) abrogated advantage.Donor DDAVP seems improve survival. Combined use should receive further evaluation.