Donor Postextubation Hypotension and Age Correlate With Outcome After Donation After Cardiac Death Transplantation

Compared with standard donors, kidneys recovered from donors after cardiac death (DCD) exhibit higher rates of delayed graft function (DGF), and DCD livers demonstrate higher rates of biliary ischemia, graft loss, and worse patient survival. Current practice limits the use of these organs based on t...

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Bibliographic Details
Published in:	Transplantation Vol. 85; no. 11; pp. 1588 - 1594
Main Authors:	HO, Karen J, OWENS, Christopher D, KO, Dicken S. C, MAIEK, Sayeed, BELCHER, John, HULL, David, TULLIUS, Stefan G, FREEMAN, Richard B, POMFRET, Elizabeth A, WHITING, Fames F, HANTO, Douglas W, KARP, Seth J, JOHNSON, Scott R, KHWAJA, Khalid, CURRY, Michael P, PAVLAKIS, Martha, MANDELBROT, Didier, POMPOSELLI, James J, SHAH, Shimul A, SAIDI, Reza F
Format:	Journal Article
Language:	English
Published:	Hagerstown, MD Lippincott 15-06-2008
Subjects:	Adult Age Factors Arterial hypertension. Arterial hypotension Biological and medical sciences Blood and lymphatic vessels Blood Pressure - physiology Cardiology. Vascular system Clinical manifestations. Epidemiology. Investigative techniques. Etiology Death Female Follow-Up Studies Fundamental and applied biological sciences. Psychology Fundamental immunology Humans Hypotension - epidemiology Hypotension - etiology Hypotension - physiopathology Incidence Intubation, Intratracheal Kidney Transplantation - methods Kidney Transplantation - physiology Liver Transplantation - methods Liver Transplantation - physiology Male Medical sciences Middle Aged Prognosis Retrospective Studies Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Survival Rate - trends Tissue and Organ Procurement - methods Tissue Donors Tissue, organ and graft immunology United States - epidemiology Ventilator Weaning - adverse effects United States Heart Suboptimal donor Human Prognosis Mortality Cardiovascular disease Transplantation Homotransplantation Treatment Surgery Arterial hypotension Donation Evolution Graft Death Circulatory system Age
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Summary:	Compared with standard donors, kidneys recovered from donors after cardiac death (DCD) exhibit higher rates of delayed graft function (DGF), and DCD livers demonstrate higher rates of biliary ischemia, graft loss, and worse patient survival. Current practice limits the use of these organs based on time from donor extubation to asystole, but data to support this is incomplete. We hypothesized that donor postextubation parameters, including duration and severity of hemodynamic instability or hypoxia might be a better predictor of subsequent graft function. We performed a retrospective examination of the New England Organ Bank DCD database, concentrating on donor factors including vital signs after withdrawal of support. Prolonged, severe hypotension in the postextubation period was a better predictor of subsequent organ function that time from extubation to asystole. For DCD kidneys, this manifested as a trend toward increased DGF. For DCD livers, this manifested as increased rates of poor outcomes. Maximizing the predictive value of this test in the liver cohort suggested that greater than 15 min between the time when the donor systolic blood pressure drops below 50 mm Hg and flush correlates with increased rates of diffuse biliary ischemia, graft loss, or death. Donor age also correlated with worse outcome. Time between profound instability and cold perfusion is a better predictor of outcome than time from extubation to asystole. If validated, this information could be used to predict DGF after DCD renal transplant and improve outcomes after DCD liver transplant.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Article-1 ObjectType-Feature-2
ISSN:	0041-1337 1534-6080
DOI:	10.1097/TP.0b013e318170b6bb