D'Aragon, Frederick1; Argawal, Arnav2; Belley Cote, Emilie1; Frenette, Anne-Julie3; Dhanani, Sonny4; Lamontagne, Francois5; Meade, Maureen6
1Anesthesia-Critical Care Medicine, McMaster University, Hamilton, Canada; 2Health Sciences, McMaster University, Hamilton, Canada; 3Pharmacie, Universite de Montreal, Montreal, Canada; 4Pediatric, Children Hospital Eastern Ontario, Ottawa, Canada; 5Medicine, Universite de Sherbrooke, Sherbrooke, Canada; 6Clinical Epidemiology and Biostatistic & Medicine, McMaster University, Hamilton, Canada

Introduction: Administration of steroids is currently recommended by North American guidelines. However, most of the recommendations are based on observational studies. Over the last few years, RCTs (randomized controlled trial) have been published on steroid administration for potential organ donors after death by neurological criteria. The aim of this systematic review was to evaluate the clinical efficacy of steroids administration and to assess the quality of these RCTs.

Objectives: The objective was to evaluate the effect of steroids administration compared to no steroids administration  on vasopressor requirement and number of organs recovered in donors after death by neurological criteria. Graft survival and acute graft rejection were also assessed.

Methods: A search through EMBASE, MEDLINE and CENTRAL was conducted from inception to February 2014. An extensive search of grey literature was also realized. RCT involving administration of steroid to donors after death by neurological criteria was included for full review. Studies were assessed in duplicate. In case of disagreement, a third party took the decision. Sought outcomes were vasopressor requirement, physiologic parameters, organ recovery and graft outcomes. If needed, trial authors were contacted for additional information. The GRADE approach was used to summarize the quality of evidence for each outcome

Results: Our search identified 2949 citations. Ninety one full text articles were assessed for eligibility. Seven met eligibility criteria and 4 articles were identified through the grey literature. There was a good agreement for relevance (minimum k=0.64) and an excellent agreement for eligibility(minimum k =1.0). Most studies administered boluses of Methylprednisolone 5-8 hours before organs recovery. There was no difference between groups on vasopressor requirement, number of organ recovered and graft outcomes in each study. When pooled, there was no difference on vasopressor requirement (3 studies;N=452,RR 0.95 [95%CI 0.83to1.08]), number of multiorgan donors (2 studies;N=309,RR 0.89 [95%CI 0.64to1.24]) or kidney graft survival at 3 months (4 studies;N=251,RR 1.00 [95%CI 0.81to1.22]). There was significant clinical and statistical heterogeneity for each of these outcomes. The quality of evidence for each outcome was very low.

Conclusion: The findings suggest no evidence to support administration of steroids in organ donors after death by neurological criteria. Several methodological challenges in donor management research need to be address for future well designed RCTs

References: N/A