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Significant 13 C NMR signal enhancement by a factor of 5000 of a barbituric acid derivative (5-methyl-5-propenyl-barbituric acid) via parahydrogen induced polarization is presented. This hyperpolarization is achieved by hydrogenating 5-methyl-5-propargyl-barbituric acid with 98% enriched para-H 2 under elevated temperature and pressure and transferring the initially created 1 H hyperpolarization with an INEPT-derived pulse sequence to 13 C. The polarization can be selectively transferred to different carbons in the barbituric acid derivative by applying different pulse delays in the INEPT pulse sequence. These results demonstrate the potential of using hyperpolarized barbituric acid derivatives as “ active ” contrast agents in MRI and visualizing their pharmacokinetics in vivo.

A 64-year-old male developed chest pain while gardening. Aortic dissection and coronary artery disease were excluded but chest computed tomography (CT) scan showed an aneurysmic enlargement of the pulmonary artery and a fluttering structure within. He underwent immediate sternotomy for replacement of the pulmonary artery. Histology showed an intimal sarcoma of both branches of the pulmonary artery. The pulmonary artery was replaced by a T-shaped Gore-Tex-prosthesis.

Background. This study evaluates the objective rate of return to work after heart transplantation (HTX) in comparison with the patients' subjective rating of their work ability and identifies predictors for return to work in a German heart transplant center. Methods. A questionnaire covering demographics, clinical data, and professional aspects was sent to 200 heart transplant recipients at least 12 months after HTX. Participation was strictly anonymous enabling reliable results concerning subjective work ability. Results. Response rate was 150 of 200 (75%). During the time after HTX, 45 of 150 (30.0%) patients had ever been in a job. Thirty-five of 95 (36.8%) patients of formal working age (

Amyloid deposition has been described in degenerative cardiac valve failure, but the prevalence, pathophysiology, and clinical indicators have not been clarified yet. Extensive histological analysis of 150 consecutive, surgically resected heart valve specimens (aortic n = 119, mitral n ± 31; 67.4 ± 1.0 years) was performed. Amyloid deposition was graded semi-quantitatively and classified by specific antisera identifying the most common amyloid proteins. Histological findings were correlated with clinical data. 119 patients had aortic valve disease: aortic stenosis (AS; 100/119; 84%), aortic regurgitation (19/119; 16%); 31 patients had mitral valve disease: mitral stenosis (7/31; 22.6%), mitral regurgitation (24/3177.4%). Amyloid was found in 83/150 (55.3%) specimens with the highest prevalence in aortic stenosis (74/100; 74%), intermediate in mitral stenosis (n = 2/7; 28.6%) and mitral regurgitation (n = 7/24; 29.2%), and lowest in aortic regurgitation (2/19; 10.5%). Moderate to severe amyloid deposition was almost exclusively found in aortic stenosis. Similarily coarse polymorphic amyloid deposits by morphologic analysis were most abundant in aortic stenosis (n = 35/100; 35%). Filamentous cloudy amyloid patterns occurred with the same frequency in aortic stenosis (n = 29/100; 29%). A combination of both was only found in aortic stenosis (n = 7/100; 7%). By immunohistochemical staining none of the most common amyloid proteins was identified. Some of the specimens were weakly stained by the apolipoprotein-AI antibody, more markedly adjacent to the amyloid fibrils. Amyloid deposition in aortic stenosis depended on hyperlipidemia, echocardiographic valvular thickening, and - by trend - on the presence of coronary artery disease, and obesity. Dystrophic valvular amyloidosis appears to represent an underestimated local manifestation of progressive destruction and scarring with diverse deposition pattern predominantly affecting stenotic aortic valves. It appears to depend on risk factors for atheroinflammatory processes and high shear-stress hemodynamic. The underlying protein structure has to be clarified in further studies.

We investigated tolerability and efficacy of ezetimibe treatment (10 mg/d) in 25 heart allograft recipients already on stable statin therapy. Total cholesterol (TC), low-density cholesterol (LDL-C), high-density cholesterol (HDL-C), triglycerides (TG), immunosuppressant drug levels, laboratory and clinical parameters were assessed before, four months and one yr after initiation of ezetimibe treatment. Mean equivalent statin dose was 53.5 +/- 12.3 mg of pravastatin, remaining unchanged throughout the study period. Ezetimibe was generally well tolerated, only two patients (8%) discontinued ezetimibe due to stomach pain or headache. Mean TC decreased from 231.8 +/- 6.4 mg/dL before therapy to 202.2 +/- 8.8 mg/dL after four months and 192.9 +/- 7.0 mg/dL after one yr (p0.001). Mean LDL-C decreased from 143.1 +/- 5.4 mg/dL to 121.4 +/- 7.9 mg/dL (month 4; p0.05) and 107.1 +/- 5.6 mg/dL (one yr; p0.001). TG decreased from 182 +/- 14.3 mg/dL to 173.3 +/- 17.5 mg/dL after one yr (p0.05), whereas HDL-C was unchanged. Initial LDL-C and cardiac diagnosis before transplantation were identified as predictors of absolute LDL-C reduction. Immunosuppressant drug doses and blood concentrations were unchanged as well as other laboratory and clinical parameters. Ezetimibe appears safe and effective for further reduction of TC and LDL-C in heart allograft recipients already on stable statin therapy. Extent of pre-treatment LDL-C and cardiac disorder prior to transplantation appear to correlate with the efficacy of ezetimibe therapy.

Introduction: The purposes of this study are to identify a patient cohort that would benefit from the use of mechanical circulatory support (MCS) in the presence of the Eurotransplant high-urgency (HU) program. Methods: Sixty-five patients (heart transplantation (HTx) group, 77%) underwent heart transplantation and 17 patients (D group, 20%) died while on the HU waiting list. These 82 patients were included in this retrospective study. Results: The mean waiting time on HU list was 18.3 17.7 days in HTx group and 12.5 9.4 days in D group (p = 0.075). The average weekly allocation rate from the active HU list was 27.7%, and the mean weekly waiting-list mortality was 12.1%. The use of intra-aortic balloon pumping (p = 0.005), mechanical ventilation (p = 0.007), higher dose of dobutamine (0.005), lower serum level of sodium (p = 0.046), and higher serum level of C reactive protein (CRP) (0.040) at the registration of HU listing were associated with waiting-time mortality, and the serum creatinine level more than 1.5 mg/dl (p = 0.007, odds ratio; 14.5, 95% CI; 2.1—102.0) and the serum CRP level more than 10 mg/l (p = 0.026, odds ratio; 6.3, 95%CI; 1.2—31.4) were identified as significant predictors. Conclusion: It would be appropriate that a patient who would not be able to tolerate one or two weeks waiting time to be considered as a candidate for MCS implantation in the presence of the HU program.The patientselectioncriteria for MCSimplantationshould include notonlyhemodynamic parameters, but also the aspectof a beginning multi-organ failure. # 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Distance measurements by electron paramagnetic resonance techniques between labels attached to biomacromolecules provide structural information on systems that cannot be crystallized or are too large to be characterized by NMR methods. However, existing techniques are limited in their distance range and sensitivity. It is anticipated by theoretical considerations that these limits could be extended by measuring the enhancement of longitudinal relaxation of a nitroxide label due to a lanthanide complex label at cryogenic temperatures. The relaxivity of the dysprosium complex with the macrocyclic ligand DOTA can be determined without direct measurements of longitudinal relaxation rates of the lanthanide and without recourse to model compounds with well defined distance by analyzing the dependence of relaxation enhancement on either temperature or concentration in homogeneous glassy frozen solutions. Relaxivities determined by the two calibration techniques are in satisfying agreement with each other. Error sources for both techniques are examined. A distance of about 2.7 nm is measured in a model compound of the type nitroxide-spacer-lanthanide complex and is found in good agreement with the distance in a modeled structure. Theoretical considerations suggest that an increase of the upper distance limit requires measurements at lower fields and temperatures.

Objective: Cardiac amyloidosis (CA) is associated with a poor prognosis and a survival rate of less than 30% 2 years after clinical manifestation. Considered as a semi-malignant disease, CA is often a contraindication for HTx; however, depending on the type of CA, there are excellent treatment regimes that can be combined with HTx. In AL-amyloidosis, chemotherapy and stem cell transplantation are necessary and in TTR-amyloidosis, where the liver is the source of the pathologic protein, liver transplantation is recommended after HTx. Methods and Results: More than 60 patients with AL-amyloidosis and more than 25 patients with ATTR-amyloidosis have been investigated at our centre. Eighteen patients showed signs of end-stage heart failure. Four patients died within 1 month after listing for HTx. Seven patients with AL (mean age 41.8 years) and five patients with ATTR-amyloidosis (mean age 42.6 years) were successfully transplanted with an actual survival rate of 91.6%. One patient died 8 months after HTx due to infection. Five AL patients received chemotherapy and SCT and one ATTR patient was liver transplanted. Three AL patients showed complete remission of amyloidosis. Conclusions: Cardiac amyloidosis is a potentially curative disease after HTx when combined with either chemotherapy and SCTor LiverTx depending on the type of the amyloidosis. Due to the natural course of the disease, urgent HTx after cardiac manifestation is mandatory. With this approach, excellent survival rates and even remission of the underlying disease is possible.

In surveys, interviewers serve as the agents of data collection. Their task includes contacting the target persons, gaining their cooperation, and conducting the interviews according to the rules of standardized interviewing. Interviewers are not equally successful at doing their job. They differ both in the quality of the data collected and in the response rate they achieve (Biemer & Lyberg, 2003, pp. 110–11, p. 156ff.). It is often difficult to distinguish to what extent these differences arise from differences among interviewers or from differences between the areas (and the target persons, living in these areas) assigned to the interviewers. Research using interpenetrated sample designs, however, has shown that interviewer effects can remain strong even when area effects are controlled (Campanelli & O’Muircheartaigh, 1999).

OBJECTIVE The Eurotransplant High-Urgency (HU) Heart Transplantation Program allows urgent heart transplants to be carried out in rapidly deteriorating patients with acute-to-chronic heart failure on the elective waiting list. But do the results of HU heart transplantation justify performing primary heart transplantation in these critically ill patients and offer an acceptable outcome? METHODS Between 2000 and 2004, 64 heart transplantations (HTx) (32 elective and 32 HU-HTx) were performed in our department. After having been accepted in an auditing process based on HU criteria, intensive care patients in NYHA functional class IV (cardiac index 1.7 l/min/qm BS), in end-organ failure (creatinine 1.5 mg/dl), and with catecholamine dependence (dobutamine 8 microg/kg/min), are given priority with respect to organ allocation, and their data were compared to data from elective patients from the same period. RESULTS HU requests were accepted in 97 % of cases. Two requests were not accepted, and both patients with contraindications for assist device implantation died within one week. The HU patients were 100 % in NYHA class IV, 93 % of the elective patients were in NYHA class III. Waiting time on the HU list was 13 days, and 7 of these patients died before HTx. Following heart transplantation, survival rates at 30 days and at one year of the HU group were 88 % and 85 % versus 94 % and 93 % in the elective group. CONCLUSIONS This study shows that end-stage heart failure patients in the HU program can be transplanted primarily with good results if an organ is available in time. We are still in the position where the HU program only manages the organ shortage; there are still too many patients on the waiting list who die before receiving a donor organ.

The early phase following heart transplantation (HTx) is characterized by the development of right ventricular myocardial fibrosis (MF) and cardiomyocyte hypertrophy (CH). The question is if there are differences in development of MF and CH between patients with complicated versus patients with uncomplicated postoperative course.Endomyocardial biopsies were taken from 58 donor hearts before implantation and one and two weeks after HTx. According to the clinical course in the first year after HTx and the rejection grading (ISHLT), four groups were classified: (a) uneventful course, (b) transplant failure, (c) infections, and (d) rejection episodesor = 1R. The volume densities of various tissue components and cardiomyocyte diameters were measured by stereological and morphometrical methods.From implantation to the first two weeks, most groups showed a significant increase of endomysial and perimysial connective tissues. There was a significant CH recognizable, especially in the rejection group. However, nucleus surface, a hypertrophy parameter, showed no significant change during follow-up. There were no statistically significant differences in volume densities of interstitial space, capillaries, nuclei and cardiomyocytes between the collectives and points in time. Sarcomere length as marker of contraction status of cardiomyocytes remained at the same level and showed no significant differences. Demographic data showed no significant differences and will be presented.Patients with complicated and uncomplicated courses show different degrees of histopathological changes after HTx. The extent of hypertrophy differs especially between the collectives. Measurement of endomysial connective tissue points to later postoperative course in the recipient. These findings may reflect a pattern of remodeling specific to the transplanted heart.

Background Growth factors such as platelet-derived growth factor (PDGF) and fibroblast growth factor (FGF) appear to play a key role in immunologic reactions in the long-term course after heart transplant. Their expression in the early phase after transplant has been recently described. The aim of the present study was, therefore, to examine the growth factor expression in the early and later periods, up to three years after transplant in the same patient cohort. Methods Right ventricular endomyocardial biopsies were obtained from 29 heart transplant recipients before implantation, after one and two weeks, and after one, two, and three years after heart transplant, and immediately frozen in liquid nitrogen. The growth factor expression was examined immunohistochemically. Results The PDGFs were mainly expressed in vascular structures and they were less pronounced in cardiomyocytes. Especially after the first week, a significant increase was found in the expression of PDGF A and B as well as PDGF-receptors α and β. In the yearly biopsies, PDGF expression was rarely found. The bFGF expression was merely weak in the later period three years after transplant and the aFGF was only expressed in the early phase. A comparison of recipients with short and long ischemic time did not reveal any significant differences in the intensity of expression. Conclusions The increased expression of PDGF and FGF in the first postoperative week can be interpreted as an unspecific reaction to peritransplant injury. This might be related to important reparative, angioprotective, and wound-healing processes shortly after the heart transplant had taken place. The weak expression in the later period appears to be linked to a stable transplant function and a direct influence by the immunosuppressive therapy.

Reduced hemoglobin (Hb) levels after heart transplantation (HTX) are common; however, there are only limited data on the association of posttransplant anemia with survival.In the present study, the effect of Hb levels determined 7 to 12 months after HTX on survival was investigated in 156 heart transplant recipients (129 men and 27 women; age at transplantation, 51.3+/-10.45 years; follow-up, 6.77+/-3.6 years) by univariate and multivariate analyses including a broad range of clinical and demographic patient characteristics.Anemia by standard definition was found in 141 of 156 (91.6%) patients. According to Hb levels above or below the gender-specific median (men, 12.07 g/dL; women, 11.69 g/dL), patients were separated into a high- or low-Hb group, respectively. Kaplan-Meier analysis demonstrated significantly worse survival in the low-Hb group (P =0.033). Those patients showed significantly lower body weight, higher serum creatinine levels, and lower calculated creatinine clearance; the association of creatinine clearance and Hb levels was highly significant (P0.0001). No differences were demonstrated between groups for age, preoperative cardiac diagnosis, diabetes, azathioprine, steroid or angiotensin-converting enzyme inhibitor medication, leukocyte and thrombocyte levels, rejection index, or cytomegalovirus (CMV) infection or serostatus. Multivariate Cox stepwise regression analysis demonstrated that CMV infection, diabetes, and female donor gender were significant risk factors for post-HTX survival. An Hb level below the median was, however, completely lost as a risk factor (P =0.44); instead, a strong trend for reduced creatinine clearance could be demonstrated (P =0.09). Subsequently, a significant association was demonstrated between low calculated creatinine clearance and impaired survival by separate Kaplan-Meier analysis (P =0.02).Low Hb levels after HTX do not represent an independent risk factor for reduced survival, but the demonstrated correlation appears to be primarily caused by concomitant functional renal impairment. Further studies will be required to investigate the role of post-HTX anemia as a sensitive indicator of functional renal impairment and the effects of anemia treatment on long-term survival.

Shallow electron spin echo envelope modulations due to dipole–dipole couplings between electron spins provide information on the radial distribution function of the spins in disordered systems while angular correlations between spin pairs are negligible. Under these conditions and in the absence of orientational selection, the dipolar time evolution data can be quantitatively simulated for arbitrary radial distribution functions by shell factorization, i.e., by performing the orientational average separately for thin spherical shells and multiplying the signals of all the shells. For distances below 5 nm, a linear superposition of the signals of the shells is sufficient. The dipolar time evolution data can be separated into this linear contribution and a nonlinear background. The linear contribution can then be converted directly to a radial distribution function. For a series of shape-persistent and flexible biradicals with end-to-end distances between 2 and 5 nm, shell factorization and direct conversion of the data are in good agreement with each other and with force-field computations of the end-to-end distances. The neglect of orientation selection does not cause significant distortions of the determined distance distributions.

Bevolkerungsreprasentative Umfragen sind in der Bundesrepublik Deutschland auf mehrstufige Auswahlverfahren bei der Stichprobenziehung angewiesen, weil — anders als z. B. in Schweden — kein zentrales Register existiert, in dem alle Einwohner verzeichnet sind (vgl. Hanefeld 1987: 145ff). Bei diesen mehrstufigen Verfahren wird in der ersten Ziehungsstufe eine Flachenstichprobe gebildet. Zur Auswahl der Flachen benotigt man eine Datengrundlage, aus der die Gesamtzahl der Flachen und — wenn die Bevolkerungszahl in den einzelnen Flachen variiert — die Bevolkerungszahl pro Flache hervorgeht. In der Bundesrepublik wird bei der Ziehung von Zufallsstichproben fur personlich-mundliche Bevolkerungsumfragen zumeist das Stichprobendesign des Arbeitskreises Deutscher Marktforschungsinstitute („ADM-Stichprobensystem“) eingesetzt, das auf Daten der Wahlbezirksstatistik des Statistischen Bundesamtes basiert. Bei diesem Verfahren wird in der ersten Stufe eine Stichprobe von Wahlbezirken gezogen. In der zweiten und dritten Auswahlstufe ermitteln die Interviewer in den ausgewahlten Wahlbezirken nach einem Zufall s verfahren die zu befragenden Haushalte und Zielpersonen. Eine Alternative zu diesem System, die in der Praxis allerdings nur selten gewahlt wird, stellt eine zweistufige Auswahl dar, bei der zunachst eine Stichprobe von Gemeinden gezogen wird und anschliesend Personenadressen aus den Einwohnermelderegistern ausgewahlt werden.

Wohl kein anderes Rechtsgebiet hat in den vergangenen Jahrzehnten international gesehen eine grosere Reformwelle erlebt als die gesetzliche Regelung des Schwangerschaftsabbruchs (vgl. Eser 1988: 5). In Deutschland stand dieses Thema mit der Vereinigung beider deutscher Staaten im Jahre 1990 wieder auf der politischen Tagesordnung: Zur Vereinheitlichung der Rechtsordnung muste eine Regelung gefunden werden, die das unterschiedliche Recht in beiden Teilen Deutschlands — in Westdeutschland ein Indikationsmodell, in Ostdeutschland eine Fristenregelung1 — ablosen sollte. Im Einigungsvertrag zwischen beiden Staaten, in dem der Beitritt der ehemaligen DDR zur Bundesrepublik Deutschland am 3. Oktober 1990 geregelt wurde, erzielte man keine einvernehmliche Losung. Um den Vertrag nicht scheitern zu lassen, vereinbarten die verantwortlichen Politiker zunachst einen zweijahrigen Aufschub, innerhalb dessen eine gesamtdeutsche Regelung gefunden werden sollte. Bis dahin sollte in beiden Teilen Deutschlands unterschiedliches Recht Gultigkeit haben.

Die Vereinigung beider deutscher Staaten hat zwei Gesellschaftssysteme zusammengefuhrt, in denen Religion und Kirche einen ganz unterschiedlichen Stellenwert haben. In der alten Bundesrepublik zahlen christliche Glaubensvorstellungen zu den anerkannten Grundwerten der gesellschaftlichen und politischen Ordnung. Den beiden grosen christlichen Kirchen wird aufgrund des Staatskirchenrechtes eine starke Position zuerkannt, so z. B. das Recht auf Steuererhebung mit staatlicher Hilfe und die Moglichkeit, konfessionellen Religionsunterricht innerhalb des staatlichen Bildungswesens zu erteilen (vgl. Kaufmann 1988). Beide Privilegien wurden den Kirchen in der ehemaligen DDR verwehrt. Nach der marxistisch-leninistischen Staatsdoktrin stellte Religion das Relikt einer vergangenen Epoche dar, welches zum Absterben verurteilt ist. Zwar war verfassungsrechtlich Religionsfreiheit garantiert, dennoch wurde auf die Kirchen phasenweise starker Druck ausgeubt und Kirchenmitglieder wurden im sozialen Leben haufig benachteiligt. Als Alternative zu kirchlichen Amtshandlungen wie der Konfirmation wurde beispielsweise die Jugendweihe eingefuhrt und Druck auf Eltern und Jugendliche zur Teilnahme ausgeubt. Bestimmte Berufe und insbesondere Fuhrungspositionen waren — mit wenigen Ausnahmen — nur Personen zuganglich, die sich nicht offen zur Kirche bekannten. Nach einer Phase der harten Konfrontation in den 50er und Anfang der 60er Jahre wurde vom Staat in der Folgezeit eine moderatere Kirchenpolitik verfolgt.

Mit AIDS ist eine neue todliche Infektionskrankheit aufgetreten, die nicht nur medizinische Probleme aufwirft, sondern auch weitreichende soziale Implikationen hat. Als mogliche Folgen dieser Krankheit werden u.a. die Veranderung von Sexualmoral und Sexualverhalten weiter Bevolkerungsteile, verstarkte Tendenzen zur Stigmatisierung und Diskriminierung sozialer Minderheiten oder die Neubewertung des Verhaltnisses zwischen dem Recht auf korperliche Unversehrtheit und den individuellen Freiheitsrechten der Burger diskutiert. Auswirkungen werden sowohl fur die Strukturen der alltaglichen sozialen Beziehungen als auch fur grundlegende soziale Institutionen wie z. B. das Gesundheitssystem oder die Rechtsprechung erwartet (vgl. Ergas 1987).1 Die soziale Dimension von AIDS betrifft jedoch nicht nur die Problematik der moglichen sozialen Konsequenzen der Krankheit, sondern umgekehrt auch die Frage der sozialen Bedingungen fur die Ausbreitung der Krankheit. Nach der Ausschaltung der Infektionsmoglichkeit durch verseuchte Blutkonserven stellen zwei soziale Verhaltensmuster die quantitativ bedeutsamsten Ubertragungswege des HIVirus dar: der gemeinsame Gebrauch unsteriler Nadeln durch Drogenabhangige und der ungeschutzte Sexualverkehr auserhalb streng monogamer Partnerschaften, wobei dieser allerdings aufgrund der unterschiedlichen HIV-Pravalenz fur die Hauptbetroffenengruppe der homosexuellen Manner ein sehr viel groseres Risiko in sich birgt als fur die sogenannte heterosexuelle „Normalbevolkerung“. Fur letztere ist eine Ansteckungsgefahr zwar vorhanden, wegen der geringen Verbreitung des Virus aber — zumindest bislang — gering.2

Auch nach der Reform des Strafrechtsparagraphen 218 im Jahr 1976 sind die Diskussionen zum Thema Schwangerschaftsabbruch stets kontrovers weitergefuhrt worden. Um die Bewertung, rechtliche Regelung und die tatsachliche Praxis drehen sich die Auseinandersetzungen zwischen Parteien, Kirchen und anderen Interessenverbanden. Die Einstellung der Bevolkerung zur Abtreibung kann damit als ein Indikator fur das offentliche Meinungsklima im Hinblick auf ein soziales Schlusselthema betrachtet werden.

We studied the incorporation of various small guest molecules into calix[4]hydroquinone nanotubes and nanoclusters using solid-state proton NMR spectroscopy in combination with quantum chemical calculations. While the molecules exhibit different types of hydrogen bonding and van der Waals interactions, they show different affinities to the nanotube host structures. As the guest molecules are located inside the complexes, they experience a shift in the NMR resonance line caused by screening effects from the aromatic electrons of the host superstructure. The abilities to fill the otherwise empty space within the tubes can hence be measured indirectly by the displacement of the NMR lines relative to the free molecules. In this way, we can probe which guest molecules are recognized by the calix[4]hydroquinones as suitable for filling their nanoporous superstructures. Selective guest-host interactions have been successfully achieved for the three component mixture of water and acetone with either 2-methyl-2-propanol or 2-propanol. In both cases, the alcohols were superior to acetone in filling the CHQ tubes.

ObjectivesWe determined the outcome of cardiac allografts from multiorgan donors enrolled in a randomized trial of donor pre-treatment with dopamine.BackgroundTreatment of the brain-dead donor with low-dose dopamine improves immediate graft function after kidney transplantation.MethodsA cohort study of 93 heart transplants from 21 European centers was undertaken between March 2004 and August 2007. We assessed post-transplant left ventricular function (LVF), requirement of a left ventricular assist device (LVAD) or biventricular assist device (BVAD), need for hemofiltration, acute rejection, and survival of recipients of a dopamine-treated versus untreated graft.ResultsDonor dopamine was associated with improved survival 3 years after transplantation (87.0% vs. 67.8%, p = 0.03). Fewer recipients of a pre-treated graft required hemofiltration after transplant (21.7% vs. 40.4%, p = 0.05). Impaired LVF (15.2% vs. 21.3%, p = 0.59), requirement of a LVAD (4.4% vs. 10.6%, p = 0.44), and biopsy-proven acute rejection (19.6% vs. 14.9%, p = 0.59) were not statistically different between groups. Post-transplant impaired LVF (hazard ratio [HR]: 4.95; 95% confidence interval [CI]: 2.08 to 11.79; p < 0.001), requirement of LVAD (HR: 6.65; 95% CI: 2.40 to 18.45; p < 0.001), and hemofiltration (HR: 2.83; 95% CI: 1.20 to 6.69; p = 0.02) were predictive of death. The survival benefit remained (HR: 0.33; 95% CI: 0.12 to 0.89; p = 0.03) after adjustment for various risks affecting mortality, including pre-transplant LVAD/BVAD, inotropic support, and impaired kidney function.ConclusionsTreatment of brain-dead donors with dopamine of 4 μg/kg/min will not harm cardiac allografts but appears to improve the clinical course of the heart allograft recipient. (Prospective Randomized Trial to Evaluate the Efficacy of Donor Preconditioning With Dopamine on Initial Graft Function After Kidney Transplantation; NCT00115115)