Copyright
©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Does the use of double hormone replacement therapy for trauma patient organ donors improve organ recovery for transplant
Eden M Gallegos, Tanner Reed, Paige Deville, Blake Platt, Claudia Leonardi, Lillian Bellfi, Jessica Dufrene, Saad Chaudhary, John Hunt, Lance Stuke, Patrick Greiffenstein, Jonathan Schoen, Alan Marr, Anil Paramesh, Alison A Smith
Eden M Gallegos, Department of Physiology, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70124, United States
Tanner Reed, Saad Chaudhary, Department of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
Paige Deville, Lillian Bellfi, John Hunt, Lance Stuke, Patrick Greiffenstein, Jonathan Schoen, Alan Marr, Alison A Smith, Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
Blake Platt, Department of Trauma Surgery, Tacoma General Hospital, Tacoma 98405, United States
Claudia Leonardi, Department of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
Jessica Dufrene, Department of Donation Services, Louisiana Organ Procurement Agency, Covington, LA 70433, United States
Anil Paramesh, Department of Surgery, Tulane Transplant Institute, Tulane University School of Medicine, New Orleans, LA 70112, United States
Author contributions: Gallegos EM wrote the first draft and revisions of the manuscript; Gallegos EM, Smith AA, Reed T, Paramesh A, Bellfi L, and Dufrene J contributed to the research design of this manuscript; Gallegos EM, Reed T, and Chaudhary S contributed to the performance of the research; Gallegos EM, Deville P, Platt B, Leonardi C, and Smith AA contributed to data analysis; Paramesh A, Smith AA, Deville P, Platt B, Leonardi C, Hunt J, Stuke L, Greiffenstein P, Schoen J, and Marr A provided critical revisions of the manuscript.
Institutional review board statement: The Louisiana State University Health Sciences Center-New Orleans Institutional Review Board approved this study (#1966), and a waiver of informed consent was obtained.
Informed consent statement: Informed consent was waived by the ethics committee because this was an observational retrospective study.
Conflict-of-interest statement: Dr. Smith reports personal fees from Prytime Medical, personal fees from Aroa Biosurgery, grants from 3M, grants from MiMedX, and grants from Dynocardia outside the submitted work.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Alison A Smith, FACS, MD, PhD, Assistant Professor, Surgeon, Department of Surgery, Louisiana State University Health Sciences Center New Orleans, 2021 Perdido Street, 8
th Floor, New Orleans, LA 70112, United States.
asmi60@lsuhsc.edu
Received: November 27, 2023
Revised: February 16, 2024
Accepted: April 16, 2024
Published online: June 18, 2024
Processing time: 200 Days and 2.7 Hours
BACKGROUND
With an ongoing demand for transplantable organs, optimization of donor management protocols, specifically in trauma populations, is important for obtaining a high yield of viable organs per patient. Endocrine management of brain-dead potential organ donors (BPODs) is controversial, leading to heterogeneous clinical management approaches. Previous studies have shown that when levothyroxine was combined with other treatments, including steroids, vasopressin, and insulin, BPODs had better organ recovery and survival outcomes were increased for transplant recipients.
AIM
To determine if levothyroxine use in combination with steroids in BPODs increased the number of organs donated in trauma patients.
METHODS
A retrospective review of adult BPODs from a single level 1 trauma center over ten years was performed. Exclusion criteria included patients who were not solid organ donors, patients who were not declared brain dead (donation after circulatory death), and patients who did not receive steroids in their hospital course. Levothyroxine and steroid administration, the number of organs donated, the types of organs donated, and demographic information were recorded. Univariate analyses were performed with P < 0.05 considered to be statistically significant.
RESULTS
A total of 88 patients met inclusion criteria, 69 (78%) of whom received levothyroxine and steroids (ST/LT group) vs 19 (22%) receiving steroids without levothyroxine (ST group). No differences were observed between the groups for gender, race, pertinent injury factors, age, or other hormone therapies used (P > 0.05). In the ST/LT group, 68.1% (n = 47) donated a high yield (3-5) of organ types per donor compared to 42.1% (n = 8) in the ST group (P = 0.038). There was no difference in the total number of organ types donated between the groups (P = 0.068).
CONCLUSION
This study suggests that combining levothyroxine and steroid administration increases high-yield organ donation per donor in BPODs in the trauma patient population. Limitations to this study include the retrospective design and the relatively small number of organ donors who met inclusion criteria. This study is unique in that it mitigates steroid administration as a confounding variable and focuses specifically on the adjunctive use of levothyroxine.
Core Tip: The present study considers the impact of combination endocrine management on the number of solid organs donated in brain-dead organ donors. Specifically, we focused on the use of steroids alone or steroids and levothyroxine in organ donors of the trauma patient population from a single level 1 trauma center. We showed a significant association between a high yield of organs donated per donor and the use of combination hormone replacement therapy as compared to steroids alone. These data complement published literature on combination endocrine management and highlight the role of levothyroxine on the number of organs recovered per organ donor.
