Thyroid Hormone Administration May Not Help Donor Heart Transplantation – A New Study
A recent trial has found that a long-standing guideline—administering thyroid hormone to brain-dead donor hearts—may not significantly improve transplantation or graft survival rates compared to saline infusion.
This data is based on the results of a study involving 15 organ procurement organizations in the U.S and included 838 brain-dead donors. The research found that intravenous levothyroxine infusion didn’t result in more successful heart transplants. Interestingly, this approach could potentially increase the recipient’s risk of severe hypertension and tachycardia.
“Our findings suggest we should halt this practice,” says Raj Dhar, MD, who participated in the trial as a professor of neurology at Washington University.
For their research design—a multicenter, parallel-group randomized trial—participants aged 14 to 55 needed to meet certain criteria: death declared according to neurologic criteria; authorization for research participation; weight greater than or equal to 45 kg; and hemodynamic instability (after fluid resuscitation receiving one or more vasopressors or inotropes).
Patients were randomized to receive either levothyroxine—reconstituted as 500 μg in 500 ml of saline and infused at a rate of 30 ml per hour, or an equal volume of normal saline. Primary outcomes measured included the success of heart transplantation from the donor and graft survival at 30 days post-transplant.
Despite expectations that thyroid hormone would yield superior results, hearts were successfully transplanted from approximately equivalent percentages for both groups (54.9% levothyroxine, vs. 53.2% control group). Moreover, there wasn’t a significant difference in incidences of weaning from vasopressor therapy, ejection fraction on echocardiography, or organs transplanted per donor.
However, researchers did observe more cases of severe hypertension and tachycardia among recipients within the levothyroxine group when compared with those in the saline group.
