Matthew B Bloom1, Shariq Raza2, Akash Bhakta3, Tyler Ewing4, Madhukar Patel5, Eric J Ley1, Daniel R Margulies1, Ali Salim6, Darren Malinoski7. 1. Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. 2. Department of Surgery, Temple University Medical Center, Philadelphia, PA. 3. Midwestern University, Glendale, AZ. 4. School of Medicine, University of California, Davis, CA. 5. Department of Surgery, Massachusetts General Hospital, Boston, MA. 6. Department of Surgery, Brigham and Women's Hospital, Boston, MA. 7. Surgical Critical Care Section, Portland Veterans Affairs Medical Center, Portland, OR; Department of Surgery, Oregon Health and Science University, Portland, OR. Electronic address: Darren.malinoski@va.gov.
Abstract
BACKGROUND: The criteria for organ acceptance remain inconsistent, which limits the ability to standardize critical care practices. We sought to examine predictors of liver graft use and survival to better guide the selection and management of potential organ donors. STUDY DESIGN: A prospective observational study of all donors managed by the 8 organ procurement organizations in United Network for Organ Sharing Region 5 was conducted from July 2008 to March 2011. Critical care end points that reflect the normal hemodynamic, acid-base, respiratory, endocrine, and renal status of the donor were collected at 3 time points. Critical care and demographic data associated with liver transplantation and graft survival rates were first determined using univariate analyses, and then logistic regression was used to identify independent predictors of these two outcomes. RESULTS: From 961 donors, 730 (76%) livers were transplanted and 694 (95%) were functioning after 74 ± 73 days of follow-up. After regression analysis, donor BMI (odds ratio [OR] = 0.94), male sex (OR = 1.89), glucose <150 mg/dL (OR = 1.97), lower dopamine dose (OR = 0.95), vasopressin use (OR = 1.95), and ejection fraction >50% (OR = 1.77) remained as independent predictors of liver use. Graft survival was associated with lower donor BMI (OR = 0.91) and sodium levels (OR = 0.95). CONCLUSIONS: After controlling for donor age, sex, and BMI, both hemodynamic and endocrine critical care end points were associated with increased liver graft use. Both donor BMI and lower sodium levels during the course of donor management were independently predictive of improved graft survival. These results may help guide the management and selection of potential organ donors after neurologic determination of death.
BACKGROUND: The criteria for organ acceptance remain inconsistent, which limits the ability to standardize critical care practices. We sought to examine predictors of liver graft use and survival to better guide the selection and management of potential organ donors. STUDY DESIGN: A prospective observational study of all donors managed by the 8 organ procurement organizations in United Network for Organ Sharing Region 5 was conducted from July 2008 to March 2011. Critical care end points that reflect the normal hemodynamic, acid-base, respiratory, endocrine, and renal status of the donor were collected at 3 time points. Critical care and demographic data associated with liver transplantation and graft survival rates were first determined using univariate analyses, and then logistic regression was used to identify independent predictors of these two outcomes. RESULTS: From 961 donors, 730 (76%) livers were transplanted and 694 (95%) were functioning after 74 ± 73 days of follow-up. After regression analysis, donor BMI (odds ratio [OR] = 0.94), male sex (OR = 1.89), glucose <150 mg/dL (OR = 1.97), lower dopamine dose (OR = 0.95), vasopressin use (OR = 1.95), and ejection fraction >50% (OR = 1.77) remained as independent predictors of liver use. Graft survival was associated with lower donor BMI (OR = 0.91) and sodium levels (OR = 0.95). CONCLUSIONS: After controlling for donor age, sex, and BMI, both hemodynamic and endocrine critical care end points were associated with increased liver graft use. Both donor BMI and lower sodium levels during the course of donor management were independently predictive of improved graft survival. These results may help guide the management and selection of potential organ donors after neurologic determination of death.
Authors: Elizabeth A Swanson; Tony Adams; Madhukar S Patel; Salvador De La Cruz; Michael Hutchens; Kiran Khush; Mitchell B Sally; Claus U Niemann; Tahnee Groat; Darren J Malinoski Journal: J Am Coll Surg Date: 2020-06-17 Impact factor: 6.113
Authors: Mitchell B Sally; Margaret Katherine Ellis; Michael Hutchens; Tahnee Groat; Elizabeth Swanson; Madhukar S Patel; Claus U Niemann; Darren J Malinoski Journal: Clin Transplant Date: 2019-06 Impact factor: 2.863
Authors: Shelby Resnick; Mark J Seamon; Daniel Holena; Jose Pascual; Patrick M Reilly; Niels D Martin Journal: J Surg Res Date: 2017-05-12 Impact factor: 2.192
Authors: Alexandra T Strauss; Tanveen Ishaque; Sharon Weeks; James P Hamilton; Cem Simsek; Christine M Durand; Allan B Massie; Dorry L Segev; Ahmet Gurakar; Jacqueline M Garonzik-Wang Journal: Transplant Direct Date: 2021-03-22
Authors: Andrew M Bishara; Dmytro S Lituiev; Dieter Adelmann; Rishi P Kothari; Darren J Malinoski; Jacob D Nudel; Mitchell B Sally; Ryutaro Hirose; Dexter D Hadley; Claus U Niemann Journal: Transplant Direct Date: 2021-09-27
Authors: Michał Grąt; Karolina M Wronka; Waldemar Patkowski; Jan Stypułkowski; Karolina Grąt; Maciej Krasnodębski; Łukasz Masior; Zbigniew Lewandowski; Marek Krawczyk Journal: Dig Dis Sci Date: 2016-02 Impact factor: 3.199