To the Editor: The study by Dr Schnuelle and colleagues1 added evidence supporting active organ donor treatment. Active donor management strategies are frequently complex and based on little outcome evidence. Although early episodes of delayed graft function and acute rejection appear to be associated with poorer long-term outcome,2 an intervention associated with a reduction in delayed graft function rate does not always result in long-term graft survival. This may explain an apparent disparity between the significantly lower allograft survival in recipients who required 2 or more episodes of renal replacement therapy and the lack of any difference found in either acute rejection episodes or long-term graft survival between the treatment and control groups.
Ball J, McAnulty G. Donor Dopamine Pretreatment and Graft Function After Kidney Transplantation. JAMA. 2010;303(3):230-232. doi:10.1001/jama.2009.1996