Thyroid hormone use during cardiac transplant organ procurement

Background Acute hypothyroidism after brain death results in hemodynamic impairments that limit availability of donor hearts. Thyroid hormone infusions can halt that process and lead to increased utilization of donor organs, but prolonged use of thyroid replacement has not been well studied. Methods...

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Vydané v:	Clinical transplantation Ročník 30; číslo 12; s. 1578 - 1583
Hlavní autori:	Cooper, Lauren B., Milano, Carmelo A., Williams, Melissa, Swafford, Wendy, Croezen, Donna, Van Bakel, Adrian B., Rogers, Joseph G., Patel, Chetan B.
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	Denmark Blackwell Publishing Ltd 01.12.2016
Predmet:	Brain Death Clinical Protocols donor management Health Care Surveys heart transplant Humans Hypothyroidism - etiology Hypothyroidism - prevention & control Practice Guidelines as Topic Practice Patterns, Physicians' - statistics & numerical data procurement survey thyroid hormone Thyroid Hormones - therapeutic use Tissue and Organ Procurement - methods United States heart transplant survey thyroid hormone procurement donor management
ISSN:	0902-0063, 1399-0012, 1399-0012
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Abstract	Background Acute hypothyroidism after brain death results in hemodynamic impairments that limit availability of donor hearts. Thyroid hormone infusions can halt that process and lead to increased utilization of donor organs, but prolonged use of thyroid replacement has not been well studied. Methods We developed a 15‐question survey regarding policies, procedures, and reporting of thyroid hormone use by organ procurement organizations (OPOs). The survey was posted for 5 weeks on the Association of OPOs Portal. Results We received 29 responses, representing 24 OPOs. Seventy‐two percent reported their OPOs use thyroid hormone for all potential donors and 90% have a protocol for thyroid hormone use. There is a large variation in the maximum dose of thyroid hormone used, and many OPOs have no weaning protocol. Most OPOs do not collect data on total thyroid hormone administered during procurement and would favor more detailed report of thyroid hormone use. Conclusions Thyroid hormone use can have important implications for organ selection and cardiac function before and after transplantation. Protocols vary widely with respect to why and how to use and wean thyroid hormone. We believe there should be more detailed reporting of thyroid hormone use for future studies to ensure appropriate donor management.
AbstractList	Acute hypothyroidism after brain death results in hemodynamic impairments that limit availability of donor hearts. Thyroid hormone infusions can halt that process and lead to increased utilization of donor organs, but prolonged use of thyroid replacement has not been well studied.BACKGROUNDAcute hypothyroidism after brain death results in hemodynamic impairments that limit availability of donor hearts. Thyroid hormone infusions can halt that process and lead to increased utilization of donor organs, but prolonged use of thyroid replacement has not been well studied.We developed a 15-question survey regarding policies, procedures, and reporting of thyroid hormone use by organ procurement organizations (OPOs). The survey was posted for 5 weeks on the Association of OPOs Portal.METHODSWe developed a 15-question survey regarding policies, procedures, and reporting of thyroid hormone use by organ procurement organizations (OPOs). The survey was posted for 5 weeks on the Association of OPOs Portal.We received 29 responses, representing 24 OPOs. Seventy-two percent reported their OPOs use thyroid hormone for all potential donors and 90% have a protocol for thyroid hormone use. There is a large variation in the maximum dose of thyroid hormone used, and many OPOs have no weaning protocol. Most OPOs do not collect data on total thyroid hormone administered during procurement and would favor more detailed report of thyroid hormone use.RESULTSWe received 29 responses, representing 24 OPOs. Seventy-two percent reported their OPOs use thyroid hormone for all potential donors and 90% have a protocol for thyroid hormone use. There is a large variation in the maximum dose of thyroid hormone used, and many OPOs have no weaning protocol. Most OPOs do not collect data on total thyroid hormone administered during procurement and would favor more detailed report of thyroid hormone use.Thyroid hormone use can have important implications for organ selection and cardiac function before and after transplantation. Protocols vary widely with respect to why and how to use and wean thyroid hormone. We believe there should be more detailed reporting of thyroid hormone use for future studies to ensure appropriate donor management.CONCLUSIONSThyroid hormone use can have important implications for organ selection and cardiac function before and after transplantation. Protocols vary widely with respect to why and how to use and wean thyroid hormone. We believe there should be more detailed reporting of thyroid hormone use for future studies to ensure appropriate donor management. Acute hypothyroidism after brain death results in hemodynamic impairments that limit availability of donor hearts. Thyroid hormone infusions can halt that process and lead to increased utilization of donor organs, but prolonged use of thyroid replacement has not been well studied. We developed a 15-question survey regarding policies, procedures, and reporting of thyroid hormone use by organ procurement organizations (OPOs). The survey was posted for 5 weeks on the Association of OPOs Portal. We received 29 responses, representing 24 OPOs. Seventy-two percent reported their OPOs use thyroid hormone for all potential donors and 90% have a protocol for thyroid hormone use. There is a large variation in the maximum dose of thyroid hormone used, and many OPOs have no weaning protocol. Most OPOs do not collect data on total thyroid hormone administered during procurement and would favor more detailed report of thyroid hormone use. Thyroid hormone use can have important implications for organ selection and cardiac function before and after transplantation. Protocols vary widely with respect to why and how to use and wean thyroid hormone. We believe there should be more detailed reporting of thyroid hormone use for future studies to ensure appropriate donor management. Background Acute hypothyroidism after brain death results in hemodynamic impairments that limit availability of donor hearts. Thyroid hormone infusions can halt that process and lead to increased utilization of donor organs, but prolonged use of thyroid replacement has not been well studied. Methods We developed a 15‐question survey regarding policies, procedures, and reporting of thyroid hormone use by organ procurement organizations (OPOs). The survey was posted for 5 weeks on the Association of OPOs Portal. Results We received 29 responses, representing 24 OPOs. Seventy‐two percent reported their OPOs use thyroid hormone for all potential donors and 90% have a protocol for thyroid hormone use. There is a large variation in the maximum dose of thyroid hormone used, and many OPOs have no weaning protocol. Most OPOs do not collect data on total thyroid hormone administered during procurement and would favor more detailed report of thyroid hormone use. Conclusions Thyroid hormone use can have important implications for organ selection and cardiac function before and after transplantation. Protocols vary widely with respect to why and how to use and wean thyroid hormone. We believe there should be more detailed reporting of thyroid hormone use for future studies to ensure appropriate donor management. Background Acute hypothyroidism after brain death results in hemodynamic impairments that limit availability of donor hearts. Thyroid hormone infusions can halt that process and lead to increased utilization of donor organs, but prolonged use of thyroid replacement has not been well studied. Methods We developed a 15-question survey regarding policies, procedures, and reporting of thyroid hormone use by organ procurement organizations (OPOs). The survey was posted for 5 weeks on the Association of OPOs Portal. Results We received 29 responses, representing 24 OPOs. Seventy-two percent reported their OPOs use thyroid hormone for all potential donors and 90% have a protocol for thyroid hormone use. There is a large variation in the maximum dose of thyroid hormone used, and many OPOs have no weaning protocol. Most OPOs do not collect data on total thyroid hormone administered during procurement and would favor more detailed report of thyroid hormone use. Conclusions Thyroid hormone use can have important implications for organ selection and cardiac function before and after transplantation. Protocols vary widely with respect to why and how to use and wean thyroid hormone. We believe there should be more detailed reporting of thyroid hormone use for future studies to ensure appropriate donor management.
Author	Patel, Chetan B. Croezen, Donna Milano, Carmelo A. Rogers, Joseph G. Van Bakel, Adrian B. Williams, Melissa Swafford, Wendy Cooper, Lauren B.
Author_xml	– sequence: 1 givenname: Lauren B. surname: Cooper fullname: Cooper, Lauren B. organization: Inova Heart & Vascular Institute, Falls Church, VA, USA – sequence: 2 givenname: Carmelo A. surname: Milano fullname: Milano, Carmelo A. organization: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA – sequence: 3 givenname: Melissa surname: Williams fullname: Williams, Melissa organization: Department of Surgery, Duke University Medical Center, NC, Durham, USA – sequence: 4 givenname: Wendy surname: Swafford fullname: Swafford, Wendy organization: Department of Surgery, Duke University Medical Center, NC, Durham, USA – sequence: 5 givenname: Donna surname: Croezen fullname: Croezen, Donna organization: Carolina Donor Services, NC, Durham, USA – sequence: 6 givenname: Adrian B. surname: Van Bakel fullname: Van Bakel, Adrian B. organization: Department of Medicine, Medical University of South Carolina, SC, Charleston, USA – sequence: 7 givenname: Joseph G. surname: Rogers fullname: Rogers, Joseph G. organization: Department of Medicine, Duke University Medical Center, Durham, NC, USA – sequence: 8 givenname: Chetan B. surname: Patel fullname: Patel, Chetan B. email: chetan.patel@duke.edu, chetan.patel@duke.edu organization: Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Cites_doi	10.1089/thy.1997.7.139 10.1097/01.TP.0000045683.85282.93 10.1001/archsurg.136.12.1377 10.1016/j.healun.2014.02.027 10.1097/00007890-198743060-00016 10.1097/01.tp.0000237195.12342.f1 10.1016/j.healun.2009.01.018 10.1161/01.CIR.0000025587.40373.75 10.1097/00003246-199007000-00004 10.1213/00000539-199607000-00008 10.1097/TP.0000000000000187
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References	Jeevanandam V. Triiodothyronine: spectrum of use in heart transplantation. Thyroid. 1997;7:139-145. Rosendale JD, Kauffman HM, McBride MA, et al. Aggressive pharmacologic donor management results in more transplanted organs. Transplantation. 2003;75:482-487. Abdelnour T, Rieke S. Relationship of hormonal resuscitation therapy and central venous pressure on increasing organs for transplant. J Heart Lung Transplant. 2009;28:480-485. Wheeldon DR, Potter CD, Oduro A, Wallwork J, Large SR. Transforming the "unacceptable" donor: outcomes from the adoption of a standardized donor management technique. J Heart Lung Transplant. 1995;14:734-742. Novitzky D, Cooper DK, Rosendale JD, Kauffman HM. Hormonal therapy of the brain-dead organ donor: experimental and clinical studies. Transplantation. 2006;82:1396-1401. Goarin JP, Cohen S, Riou B, et al. The effects of triiodothyronine on hemodynamic status and cardiac function in potential heart donors. Anesth Analg. 1996;83:41-47. Kobashigawa J, Zuckermann A, Macdonald P, et al. Report from a consensus conference on primary graft dysfunction after cardiac transplantation. J Heart Lung Transplant. 2014;33:327-340. Powner DJ, Hendrich A, Lagler RG, Ng RH, Madden RL. Hormonal changes in brain dead patients. Crit Care Med. 1990;18:702-708. Salim A, Vassiliu P, Velmahos GC, et al. The role of thyroid hormone administration in potential organ donors. Arch Surg. 2001;136:1377-1380. Jeevanandam V, Todd B, Regillo T, Hellman S, Eldridge C, McClurken J. Reversal of donor myocardial dysfunction by triiodothyronine replacement therapy. J Heart Lung Transplant 1994;13:681-687. Novitzky D, Cooper DK, Reichart B. Hemodynamic and metabolic responses to hormonal therapy in brain-dead potential organ donors. Transplantation. 1987;43:852-854. Zaroff JG, Rosengard BR, Armstrong WF, et al. Consensus conference report: maximizing use of organs recovered from the cadaver donor: Cardiac recommendations, March 28-29, 2001, Crystal City, Va. Circulation. 2002;106:836-841. Novitzky D, Mi Z, Sun Q, Collins JF, Cooper DK. Thyroid hormone therapy in the management of 63 593 brain-dead organ donors: a retrospective analysis. Transplantation. 2014;98:1119-1127. 2006; 82 1987; 43 1990; 18 1995; 14 1996; 83 2002; 106 1994; 13 2003; 75 2001; 136 2014; 33 1997; 7 2014; 98 2009; 28 e_1_2_8_14_1 Wheeldon DR (e_1_2_8_4_1) 1995; 14 e_1_2_8_3_1 e_1_2_8_2_1 e_1_2_8_5_1 e_1_2_8_7_1 e_1_2_8_6_1 e_1_2_8_9_1 e_1_2_8_8_1 e_1_2_8_10_1 Jeevanandam V (e_1_2_8_13_1) 1994; 13 e_1_2_8_11_1 e_1_2_8_12_1 7947885 - J Heart Lung Transplant. 1994 Jul-Aug;13(4):681-7; discussion 685-7 3296351 - Transplantation. 1987 Jun;43(6):852-4 9086582 - Thyroid. 1997 Feb;7(1):139-45 17164704 - Transplantation. 2006 Dec 15;82(11):1396-401 12176957 - Circulation. 2002 Aug 13;106(7):836-41 7578183 - J Heart Lung Transplant. 1995 Jul-Aug;14(4):734-42 19416777 - J Heart Lung Transplant. 2009 May;28(5):480-5 24661451 - J Heart Lung Transplant. 2014 Apr;33(4):327-40 12605114 - Transplantation. 2003 Feb 27;75(4):482-7 2194745 - Crit Care Med. 1990 Jul;18(7):702-8 11735863 - Arch Surg. 2001 Dec;136(12):1377-80 8659763 - Anesth Analg. 1996 Jul;83(1):41-7 25405914 - Transplantation. 2014 Nov 27;98(10):1119-27
References_xml	– reference: Powner DJ, Hendrich A, Lagler RG, Ng RH, Madden RL. Hormonal changes in brain dead patients. Crit Care Med. 1990;18:702-708. – reference: Novitzky D, Cooper DK, Rosendale JD, Kauffman HM. Hormonal therapy of the brain-dead organ donor: experimental and clinical studies. Transplantation. 2006;82:1396-1401. – reference: Jeevanandam V, Todd B, Regillo T, Hellman S, Eldridge C, McClurken J. Reversal of donor myocardial dysfunction by triiodothyronine replacement therapy. J Heart Lung Transplant 1994;13:681-687. – reference: Abdelnour T, Rieke S. Relationship of hormonal resuscitation therapy and central venous pressure on increasing organs for transplant. J Heart Lung Transplant. 2009;28:480-485. – reference: Jeevanandam V. Triiodothyronine: spectrum of use in heart transplantation. Thyroid. 1997;7:139-145. – reference: Wheeldon DR, Potter CD, Oduro A, Wallwork J, Large SR. Transforming the "unacceptable" donor: outcomes from the adoption of a standardized donor management technique. J Heart Lung Transplant. 1995;14:734-742. – reference: Novitzky D, Cooper DK, Reichart B. Hemodynamic and metabolic responses to hormonal therapy in brain-dead potential organ donors. Transplantation. 1987;43:852-854. – reference: Goarin JP, Cohen S, Riou B, et al. The effects of triiodothyronine on hemodynamic status and cardiac function in potential heart donors. Anesth Analg. 1996;83:41-47. – reference: Rosendale JD, Kauffman HM, McBride MA, et al. Aggressive pharmacologic donor management results in more transplanted organs. Transplantation. 2003;75:482-487. – reference: Kobashigawa J, Zuckermann A, Macdonald P, et al. Report from a consensus conference on primary graft dysfunction after cardiac transplantation. J Heart Lung Transplant. 2014;33:327-340. – reference: Novitzky D, Mi Z, Sun Q, Collins JF, Cooper DK. Thyroid hormone therapy in the management of 63 593 brain-dead organ donors: a retrospective analysis. Transplantation. 2014;98:1119-1127. – reference: Zaroff JG, Rosengard BR, Armstrong WF, et al. Consensus conference report: maximizing use of organs recovered from the cadaver donor: Cardiac recommendations, March 28-29, 2001, Crystal City, Va. Circulation. 2002;106:836-841. – reference: Salim A, Vassiliu P, Velmahos GC, et al. The role of thyroid hormone administration in potential organ donors. 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Snippet	Background Acute hypothyroidism after brain death results in hemodynamic impairments that limit availability of donor hearts. Thyroid hormone infusions can... Acute hypothyroidism after brain death results in hemodynamic impairments that limit availability of donor hearts. Thyroid hormone infusions can halt that... Background Acute hypothyroidism after brain death results in hemodynamic impairments that limit availability of donor hearts. Thyroid hormone infusions can...
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SubjectTerms	Brain Death Clinical Protocols donor management Health Care Surveys heart transplant Humans Hypothyroidism - etiology Hypothyroidism - prevention & control Practice Guidelines as Topic Practice Patterns, Physicians' - statistics & numerical data procurement survey thyroid hormone Thyroid Hormones - therapeutic use Tissue and Organ Procurement - methods United States
Title	Thyroid hormone use during cardiac transplant organ procurement
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