John Basmaji1,2, Christine Reed3, Bram Rochwerg4,5, Ian M Ball6,7. 1. Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. jbasmaji@uwo.ca. 2. London Health Sciences Centre, Victoria Hospital, Rm D2-528, 800 Commissioners Road East, London, ON, N6A 5W9, Canada. jbasmaji@uwo.ca. 3. Faculté de Médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada. 4. Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada. 5. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. 6. Division of Critical Care, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. 7. Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
Abstract
PURPOSE: We performed a systematic review of the literature to identify the ideal blood pressure (BP) target in neurologically deceased organ donors to optimize outcomes of recipient organ function and survival, and organs transplanted per donor. SOURCE: We searched MEDLINE and EMBASE from inception to December 2018 for studies that evaluated BP targets in neurologically deceased organ donors. A two-step review process with three independent reviewers was employed. We assessed the risk of bias and applied Grading of Recommendations Assessment, Development, and Evaluation methodology to evaluate the certainty of the evidence by outcome. PRINCIPAL FINDINGS: Twelve cohort studies were included in our final analysis. Seven studies showed that hypotension was associated with worse post-transplant graft function or survival, while three studies found no association between hypotension and post-transplant graft function or survival. Two other studies showed no association between hypotension and organs transplanted per donor. Overall, six of the identified studies had serious risk of bias. CONCLUSION: A systolic BP less 90 mmHg may be associated with graft dysfunction in kidney recipients, but this is based on very low certainty in evidence. Although an ideal and universal BP target in neurologically deceased organ donors is not clearly identifiable in the literature, this could reflect the complexity of donor hemodynamics and the need for individualized targets for different organs. Further prospective research is required to address these questions.
PURPOSE: We performed a systematic review of the literature to identify the ideal blood pressure (BP) target in neurologically deceased organ donors to optimize outcomes of recipient organ function and survival, and organs transplanted per donor. SOURCE: We searched MEDLINE and EMBASE from inception to December 2018 for studies that evaluated BP targets in neurologically deceased organ donors. A two-step review process with three independent reviewers was employed. We assessed the risk of bias and applied Grading of Recommendations Assessment, Development, and Evaluation methodology to evaluate the certainty of the evidence by outcome. PRINCIPAL FINDINGS: Twelve cohort studies were included in our final analysis. Seven studies showed that hypotension was associated with worse post-transplant graft function or survival, while three studies found no association between hypotension and post-transplant graft function or survival. Two other studies showed no association between hypotension and organs transplanted per donor. Overall, six of the identified studies had serious risk of bias. CONCLUSION: A systolic BP less 90 mmHg may be associated with graft dysfunction in kidney recipients, but this is based on very low certainty in evidence. Although an ideal and universal BP target in neurologically deceased organ donors is not clearly identifiable in the literature, this could reflect the complexity of donor hemodynamics and the need for individualized targets for different organs. Further prospective research is required to address these questions.
Entities:
Keywords:
brain death; hemodynamics; tissue and organ procurement
Authors: X Rébillard; G Mourad; J P Cristol; J P Daurès; F Iborra; J Guiter; C Mion; D Grasset Journal: Presse Med Date: 1991-11-27 Impact factor: 1.228