甲状腺激素对脑死亡器官供体的影响：系统回顾和荟萃分析。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-04-29 DOI:10.1016/j.transproceed.2025.03.028

Luís Fernando Ferreira Cavalcante , Alonzo Armani Prata , Caio Rezende Lima , Gabriela Blanco Stutz , Thalia Melamed , Paulo Ricardo Gessolo Lins , Alexandra Régia Dantas Brígido

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引用次数: 0

摘要

在脑死亡供体中给予甲状腺激素（TH）已被提出作为提高器官移植活力的策略，以解决脑死亡引起的神经内分泌功能不全。虽然有证据表明有潜在的益处，如血液动力学稳定和器官功能增强，但TH替代对供体利用率和移植结果的影响尚不清楚。方法：我们对随机对照试验（RCT）进行了系统回顾和荟萃分析，比较TH给药与安慰剂或标准治疗。使用随机效应模型合并平均差异（MD）和95%置信区间（CI）的风险比（RR），并使用I2评估异质性。结果：共纳入6项研究，涉及1197名脑死亡器官捐献者。其中，601人接受了TH治疗，597人接受了安慰剂或标准治疗。总体而言，移植心脏数量(RR 0.99；95% ci 0.84-1.17；P = 0.92)，肺(RR 1.07；95% ci 0.65-1.75；p 0.80)，肝脏(RR 1.00；95% ci 0.78-1.28；P = 0.99)，组间相似。心脏指数组间差异无统计学意义(MD -0.05；95% CI -0.28 ~ 0.19；P = .71)，其他血液动力学参数也有类似的趋势，包括心率(MD 5.11；95% CI -1.47 - 11.69；P = 0.13)，肺毛细血管楔压(MD -0.02；95% CI -1.54 ~ 1.50；P = 0.98)，中心静脉压(MD = 0.76；95% CI -0.63 ~ 2.14；P = .28)，表明与安慰剂或标准治疗相比，给予TH治疗并没有显著改变这些指标。结论：我们的数据表明，对脑死亡的潜在器官供者施用TH不会有效增加器官移植数量，也不会影响血液动力学参数。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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The Impact of Thyroid Hormones on Brain-Dead Organ Donors: A Systematic Review and Meta-Analysis

Introduction

The administration of thyroid hormones (TH) in brain-dead donors has been proposed as a strategy to improve organ viability for transplantation, addressing the neuroendocrine insufficiency caused by brain death. While evidence suggests potential benefits, such as hemodynamic stabilization and enhanced organ function, the impact of TH replacement on donor utilization rates and transplant outcomes remains unclear.

Methods

We performed a systematic review and meta-analysis of randomized controlled trials (RCT) comparing TH administration with placebo or standard-of-care. Mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random-effects model, and Heterogeneity was assessed using I².

Results

Six studies involving a total of 1,197 brain-dead organ donors were included. Of these, 601 received TH, while 597 were given either a placebo or standard-of-care treatment. Overall, the number of transplanted hearts (RR 0.99; 95% CI 0.84-1.17; P = .92), lungs (RR 1.07; 95% CI 0.65-1.75; p 0.80), and livers (RR 1.00; 95% CI 0.78-1.28; P = .99) was similar between groups. Cardiac index showed no significant difference between groups (MD –0.05; 95% CI –0.28 to 0.19; P = .71), and similar trends were observed for other hemodynamic parameters, including heart rate (MD 5.11; 95% CI –1.47 to 11.69; P = .13), pulmonary capillary wedge pressure (MD -0.02; 95% CI –1.54 to 1.50; P = .98), and central venous pressure (MD 0.76; 95% CI –0.63 to 2.14; P = .28), indicating that TH administration did not significantly alter these measures compared to placebo or standard-of-care treatment.

Conclusion

Our data suggest that administering TH to brain-dead potential organ donors does not effectively increase the number of organ transplants and has no impact on hemodynamic parameters.

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.