IMPROVED OXYGENATION AND INCREASED LUNG DONOR RECOVERY WITH HIGH-DOSESTEROID-ADMINISTRATION AFTER BRAIN-DEATH

Background: The number of patients waiting lung transplantation greatl y exceeds the supply of donors. This study was conducted to determine the effect of high-dose steroid administration on oxygenation and dono r lung recovery after brain death. Methods: A retrospective analysis w as conducted on 118 consecutive organ donors from January 1 through De cember 31, 1995. Eighty donors received high-dose steroids (methylpred nisolone, mean 14.5 +/- 0.06 mg/kg) after organ procurement organizati on management began; a second group was composed of 38 patients who re ceived no steroids. PaO2/FiO(2) ratios were used to evaluate oxygenati on. The number of single and double lungs transplanted served as the e ndpoint. Results: No differences were noted in hemodynamics, most clin ical or demographic variables and initial values of PaO2/FiO(2) betwee n groups. However, nonsteroid-treated donors showed an overall decreas e in oxygenation (mean decrease in PaO2/FiO(2) -34.2 +/- 14), whereas steroid-treated donors had a significant and progressive increase in o xygenation (mean increase in PaO2/FiO(2): 16 +/- 14) before aortic cro ss-clamping (p = 0.01). Time before cross-clamping was longer in the s teroid-treated patients (p = 0.003). The number of procured lungs was markedly greater in steroid-treated than nonsteroid-treated donors (25 /80 patients vs 3/38;p < 0.01). Conclusions: High-dose methylprednisol one given during donor management results in improved oxygenation at o rgan recovery. This treatment resulted in a significant increase in th e number of lungs transplanted and may have enabled donors to be treat ed longer.