Reversal of donor myocardial dysfunction by triiodothyronine replacement therapy

V. Jeevanandam, B. Todd, T. Regillo, S. Hellman, C. Eldridge, J. McClurken, D. Novitzky, S. Schueler, V. Gudas, C. Potter, J. Southard, M. L. Barr, W. A. Baumgartner

Research output: Contribution to journalArticlepeer-review

Abstract

Triiodothyronine deficiency after brain death can result in progressive deterioration of cardiac function in potential organ donors. We report on the use of triiodothyronine replacement in improving myocardial function, allowing the use of donor hearts that might have been considered unsuitable for transplantation. From July to September 1992, of 24 organ procurements and transplantations, six donors were receiving high doses of inotropes with elevated left-sided filling pressures. Donor characteristics were as follows: five were male donors and one was a female donor, with mean age 16.50 ± 7.50 years (8 to 30 years), mean weight 49.17 ± 13.64 kg (25 to 63 kg), average time from clinical brain death to procurement 94.50 ± 73.53 hours (49 to 240 hours), and two donors had arrest periods of up to 10 minutes. Despite large inotrope infusions, echocardiograms showed depressed left ventricular function (mean ejection fraction 39.17 ± 5.85) and hemodynamic instability was present with elevated ventricular filling pressures. Triiodothyronine replacement (maximal dose 0.6 μg/kg) was initiated an average of 139.17 ± 32.00 minutes (115 to 185 minutes) before procurement. At the time of procurement, ventricular filling pressures were lower, hemodynamic condition stabilized, and pressor requirements decreased. Hearts were preserved in University of Wisconsin solution with a mean ischemic time of 188.83 ± 36.86 minutes (149 to 237 minutes). Four hours after transplantation, hemodynamic data were as follows: mean systolic blood pressure 102.00 ± 14.42 mm Hg (80 to 120 mm Hg), mean heart rate 115.00 ± 14.14 beats/min (100 to 140 beats/min), mean central venous pressure 10.17 ± 1.17 mm Hg (9 to 12 mm Hg), mean cardiac index 3.4 ± 0.79 L/min/m2 (2.4 to 4.1 L/min/m2), mean dopamine 3.07 ± 0.65 μg/kg/min (2 to 3.5 μg/kg/min), mean isoproterenol 1.03 ± 0.40 μg/min, and two patients were receiving epinephrine, 2 μg/min. Echocardiograms at 1 week were normal, with an ejection fraction of greater than 50% in all patients. All patients survived and were discharged an average of 13.60 days (8 to 28 days) after transplantation; none required pacemakers. Triiodothyronine replacement is beneficial in salvaging donor hearts with depressed function. This therapy can increase the effective donor pool and help alleviate the critical shortage of donor organs.

Original languageEnglish (US)
Pages (from-to)681-687
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume13
Issue number4
StatePublished - 1994
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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