Elizabeth A Swanson1, Madhukar S Patel, Tahnee Groat, Nora E Jameson, Margaret K M Ellis, Michael P Hutchens, Claus U Niemann, Darren J Malinoski, Mitchell B Sally. 1. From the Medical Scientist Training Program (E.A.S.), Oregon Health and Science University, Portland, Oregon; Department of Surgery (M.S.P.), Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada; Surgical Critical Care Section (T.G., N.E.J., M.K.M.E., M.P.H., D.J.M., M.B.S.), Veterans Affairs Portland Health Care System; Department of Anesthesiology and Perioperative Medicine (M.K.M.E.), Oregon Health and Science University, Portland, Oregon; Department of Anesthesia and Perioperative Care (C.U.N.), University of California San Francisco, San Francisco, California; and Department of Surgery (D.J.M., M.B.S.), Oregon Health and Science University, Portland, Oregon.
Abstract
BACKGROUND: Delayed graft function (DGF), the need for dialysis in the first week following kidney transplant, affects approximately one quarter of deceased-donor kidney transplant recipients. Donor demographics, donor serum creatinine, and graft cold ischemia time are associated with DGF. However, there is no consensus on the optimal management of hemodynamic instability in organ donors after brain death (DBDs). Our objective was to determine the relationship between vasopressor selection during donor management and the development of DGF. METHODS: Prospective observational data, including demographic and critical care parameters, were collected for all DBDs managed by 17 organ procurement organizations from nine Organ Procurement and Transplantation Network Regions between 2012 and 2018. Recipient outcome data were linked with donor data through donor identification numbers. Donor critical care parameters, including type of vasopressor and doses, were recorded at three standardized time points during donor management. The analysis included only donors who received at least one vasopressor at all three time points. Vasopressor doses were converted to norepinephrine equivalent doses and analyzed as continuous variables. Univariate analyses were conducted to determine the association between donor variables and DGF. Results were adjusted for known predictors of DGF using binary logistic regression. RESULTS: Complete data were available for 5,554 kidney transplant recipients and 2,985 DBDs. On univariate analysis, donor serum creatinine, donor age, donor subtype, kidney donor profile index, graft cold ischemia time, phenylephrine dose, and dopamine dose were associated with DGF. After multivariable analysis, increased donor serum creatinine, donor age, kidney donor profile index, graft cold ischemia time, and phenylephrine dose remained independent predictors of DGF. CONCLUSION: Higher doses of phenylephrine were an independent predictor of DGF. With the exception of phenylephrine, the selection and dose of vasopressor during donor management did not predict the development of DGF. LEVEL OF EVIDENCE: Prognostic study, Level III.
BACKGROUND: Delayed graft function (DGF), the need for dialysis in the first week following kidney transplant, affects approximately one quarter of deceased-donor kidney transplant recipients. Donor demographics, donor serum creatinine, and graft cold ischemia time are associated with DGF. However, there is no consensus on the optimal management of hemodynamic instability in organ donors after brain death (DBDs). Our objective was to determine the relationship between vasopressor selection during donor management and the development of DGF. METHODS: Prospective observational data, including demographic and critical care parameters, were collected for all DBDs managed by 17 organ procurement organizations from nine Organ Procurement and Transplantation Network Regions between 2012 and 2018. Recipient outcome data were linked with donor data through donor identification numbers. Donor critical care parameters, including type of vasopressor and doses, were recorded at three standardized time points during donor management. The analysis included only donors who received at least one vasopressor at all three time points. Vasopressor doses were converted to norepinephrine equivalent doses and analyzed as continuous variables. Univariate analyses were conducted to determine the association between donor variables and DGF. Results were adjusted for known predictors of DGF using binary logistic regression. RESULTS: Complete data were available for 5,554 kidney transplant recipients and 2,985 DBDs. On univariate analysis, donor serum creatinine, donor age, donor subtype, kidney donor profile index, graft cold ischemia time, phenylephrine dose, and dopamine dose were associated with DGF. After multivariable analysis, increased donor serum creatinine, donor age, kidney donor profile index, graft cold ischemia time, and phenylephrine dose remained independent predictors of DGF. CONCLUSION: Higher doses of phenylephrine were an independent predictor of DGF. With the exception of phenylephrine, the selection and dose of vasopressor during donor management did not predict the development of DGF. LEVEL OF EVIDENCE: Prognostic study, Level III.
Authors: Robert M Kotloff; Sandralee Blosser; Gerard J Fulda; Darren Malinoski; Vivek N Ahya; Luis Angel; Matthew C Byrnes; Michael A DeVita; Thomas E Grissom; Scott D Halpern; Thomas A Nakagawa; Peter G Stock; Debra L Sudan; Kenneth E Wood; Sergio J Anillo; Thomas P Bleck; Elling E Eidbo; Richard A Fowler; Alexandra K Glazier; Cynthia Gries; Richard Hasz; Dan Herr; Akhtar Khan; David Landsberg; Daniel J Lebovitz; Deborah Jo Levine; Mudit Mathur; Priyumvada Naik; Claus U Niemann; David R Nunley; Kevin J O'Connor; Shawn J Pelletier; Omar Rahman; Dinesh Ranjan; Ali Salim; Robert G Sawyer; Teresa Shafer; David Sonneti; Peter Spiro; Maryam Valapour; Deepak Vikraman-Sushama; Timothy P M Whelan Journal: Crit Care Med Date: 2015-06 Impact factor: 7.598
Authors: D J Malinoski; M S Patel; O Ahmed; M C Daly; S Mooney; C O Graybill; C E Foster; A Salim Journal: Am J Transplant Date: 2013-02-13 Impact factor: 8.086
Authors: Peter Schnuelle; Uwe Gottmann; Simone Hoeger; Detlef Boesebeck; Werner Lauchart; Christel Weiss; Michael Fischereder; Karl-Walter Jauch; Uwe Heemann; Martin Zeier; Christian Hugo; Przemyslaw Pisarski; Bernhard K Krämer; Kai Lopau; Axel Rahmel; Urs Benck; Rainer Birck; Benito Antonio Yard Journal: JAMA Date: 2009-09-09 Impact factor: 56.272