Associations of Vasopressin and Corticosteroid Therapy with Organ Yield in Brain-Dead Donors: A Multicenter Cohort Study in Japan.

BACKGROUND

Optimizing intensive care management of cases in which donors are brain-dead is essential to maximize the number of transplantable organs. Hormone replacement therapy, including vasopressin and corticosteroids, is widely used to stabilize donor hemodynamics; however, its impact on organ procurement remains uncertain. This study aimed to evaluate the association between vasopressin, corticosteroid therapy, and organ yield among donors who were brain-dead.

METHODS

We conducted a multicenter, retrospective analysis of the Japan Comprehensive Process for End-of-Life Care and Organ Donation after Brain Death (J-RESPECT) cohort, including data from 16 institutions in Japan between 17 July 2010 and 31 December 2023. Donors were classified into high-yield (≥ 6 organs) and low-yield (≤ 5 organs) groups based on the median number of organs procured. Vasopressin and corticosteroid doses were categorized, and generalized estimating equations were applied to assess associations with high-yield procurement and organ-specific donation, adjusting for donor characteristics and clinical variables.

RESULTS

The median donor age was 47 years, 92 donors (45.1%) were female, and the median time from admission to procurement was 10 days. Donors in the high-yield group (n = 125) had a median of seven organs procured compared with four in the low-yield group (n = 79). After adjustment for donor characteristics, concurrent catecholamine support, and the number of organs requested by the family, low-dose methylprednisolone (< 15 mg/kg/day) was associated with higher odds of high-yield organ procurement (odds ratios, 2.86; 95% confidence intervals, 1.45-5.63), whereas vasopressin dose was not. In exploratory organ-specific analyses, high-dose methylprednisolone (≥ 15 mg/kg/day) was associated with left lung procurement, whereas no consistent associations were observed for other organs.

CONCLUSIONS

In this multicenter cohort study, low-dose methylprednisolone, but not vasopressin dose, was associated with higher organ yield after adjustment for important clinical confounders. These findings should be interpreted cautiously and warrant confirmation in prospective studies to better define the role of individual hormone replacement therapies in donor case management.