The effect of norepinephrine versus dopamine in renal transplant recipients on postoperative graft function

Finding the ideal vasopressor for use during the crucial phase of graft anastomosis is still an ongoing search to improve graft function in recipients of renal transplants. This study aimed to compare the effect of norepinephrine versus dopamine on renal graft function and postoperative serum creatinine. A randomized single-blind clinical trial of 44 patients was divided into two equal groups. Group N: norepinephrine infusion was used at a starting dose of 0.05μg/kg/min with dose range: 0.05–0.15 μ/kg/min and group D; dopamine infusion was used at a starting dose of 5μg/kg/min with dose range: 5–15 μ/kg/min. Postoperative serum creatinine and renal doppler resistive index, were compared between the two groups. There were significant differences within and between both groups over time regarding postoperative serum creatinine levels (group D, P-value < 0.001, group N, P-value < 0.001 and between both groups, P-value=0.013). Regarding the hemodynamics, after perfusion of the new renal graft, at 30 min the norepinephrine group had lower HR than dopamine group (P-value=0.031), at 20 and 30 min the norepinephrine group had higher CVP than dopamine group (P-value=0.015 and 0.022 respectively), at immediate time of perfusion (0 time) and 20 min post perfusion, the dopamine group had higher UOP than norepinephrine group (P-value=0.012 and 0.001 respectively), while there was no significant difference in the postoperative hemodynamic data. Norepinephrine and dopamine have comparable effects on graft function in the renal recipient patients.

在肾移植患者移植物吻合（graft anastomosis）的关键阶段，寻找理想的血管升压药（vasopressor）仍是改善移植肾功能的持续研究方向。本研究旨在比较去甲肾上腺素（norepinephrine）与多巴胺（dopamine）对移植肾功能及术后血清肌酐（serum creatinine）的影响。本研究纳入44例患者开展随机单盲临床试验，将其均分为两组：N组予以去甲肾上腺素静脉输注，初始剂量为0.05μg/kg/min，给药剂量范围为0.05~0.15μg/kg/min；D组予以多巴胺静脉输注，初始剂量为5μg/kg/min，给药剂量范围为5~15μg/kg/min。本研究对比了两组患者的术后血清肌酐水平及肾多普勒阻力指数（renal doppler resistive index）。术后血清肌酐水平随时间在组内及组间均存在显著差异：D组P<0.001，N组P<0.001，两组间比较P=0.013。血流动力学方面：新肾移植灌注后，术后30分钟时去甲肾上腺素组的心率（heart rate, HR）低于多巴胺组（P=0.031）；术后20分钟及30分钟时，去甲肾上腺素组的中心静脉压（central venous pressure, CVP）高于多巴胺组（分别为P=0.015与P=0.022）；在灌注即刻（0时刻）及灌注后20分钟，多巴胺组的尿量（urine output, UOP）高于去甲肾上腺素组（分别为P=0.012与P=0.001）；而两组术后血流动力学数据无显著差异。去甲肾上腺素与多巴胺对肾移植受者的移植肾功能影响相当。