Deceased Donor Management and Demographic Factors Related to Kidney Allograft Rejection and Graft Survival

Abstract Background There is agreement that the number of organ donors and the number of organs recovered per donor are not maximized despite promotion of awareness and new guidelines for transplant teams. A single standard for donor management does not exist, in part because there is no consensus w...

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Bibliographic Details
Published in:	Transplantation proceedings Vol. 42; no. 5; pp. 1513 - 1518
Main Authors:	Slakey, L.M, Slakey, C.M, Slakey, D.P
Format:	Journal Article
Language:	English
Published:	Amsterdam Elsevier Inc 01-06-2010 Elsevier
Subjects:	Adolescent Adult Biological and medical sciences Cadaver Continental Population Groups Creatinine - blood Female Fundamental and applied biological sciences. Psychology Fundamental immunology Graft Rejection - epidemiology Graft Rejection - prevention & control Graft Survival - physiology Humans Kidney Transplantation - mortality Kidney Transplantation - pathology Kidney Transplantation - physiology Male Medical sciences Middle Aged Miscellaneous Nephrectomy Public health. Hygiene Public health. Hygiene-occupational medicine Regression Analysis Retrospective Studies Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Survival Analysis Tissue Donors - statistics & numerical data Tissue, organ and graft immunology Transplantation, Homologous - physiology Treatment Outcome Graft(material) Prognosis Transplantation Homotransplantation Survival Kidney Medicine Rejection Clinical management Treatment Urinary system Donor Surgery Risk factor Graft Cadaver Public health
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Summary:	Abstract Background There is agreement that the number of organ donors and the number of organs recovered per donor are not maximized despite promotion of awareness and new guidelines for transplant teams. A single standard for donor management does not exist, in part because there is no consensus with respect to donor factors and management effect on transplant outcomes. Methods This retrospective study analyzed the long-term outcomes of 402 deceased donor kidney transplant recipients with respect to donor factors. This study differed from previous studies in that all recipients were treated with the same selection and immunosuppressive protocols. Results Factors associated with improved graft survival included cause of death, more organs donated, and lower peak sodium ( P < .01). Delayed graft function (DGF) decreased if more organs were donated, but increased when the donor was given dopamine. Recipients of donor kidneys with higher final creatinine values were more likely to show DGF ( P < .01). A decrease in acute rejection episodes was observed among patients whose donors had received dopamine, donated more organs, and had a shorter time between incision and cross clamp ( P < .05). Kidneys from donors with a higher final creatinine displayed fewer rejection episodes; those with a higher peak creatinine experienced more rejection episodes ( P < .05). Conclusion The effect of donor variables on kidney transplant outcomes is important and may not be consistent with traditional expectations. Additional data collection and assessment of both short- and long-term transplant outcomes are critical to improve our understanding of the impact of deceased donor factors and management.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0041-1345 1873-2623
DOI:	10.1016/j.transproceed.2009.12.076