Impact of spontaneous donor hypothermia on graft outcomes after kidney transplantation

• Published in: American journal of transplantation Vol. 18; no. 3; pp. 704 - 714
• Main Authors: Schnuelle, P., Mundt, H. M., Drüschler, F., Schmitt, W. H., Yard, B. A., Krämer, B. K., Benck, U.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01-03-2018
• Subjects: Body temperature; Brain Death; Brain injury; Case-Control Studies; clinical research/practice; Creatinine; delayed graft function (DGF); Delayed Graft Function - epidemiology; Dialysis; donors and donation: donation after brain death (DBD); Dopamine; Female; Follow-Up Studies; Glomerular Filtration Rate; Graft Survival; Humans; Hypothermia; Incidence; kidney (allograft) function/dysfunction; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - surgery; Kidney Function Tests; Kidney transplantation; Kidney Transplantation - mortality; kidney transplantation/nephrology; Kidney transplants; Male; Middle Aged; organ procurement; organ procurement and allocation; Prognosis; Retrospective Studies; Risk Factors; Survival; Survival Rate; Tissue Donors - supply & distribution; organ procurement; clinical research/practice; kidney transplantation/nephrology; organ procurement and allocation; graft survival; kidney (allograft) function/dysfunction; delayed graft function (DGF); donors and donation: donation after brain death (DBD)
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.14541

A previous donor intervention trial found that therapeutic hypothermia reduced delayed graft function (DGF) after kidney transplantation. This retrospective cohort study nested in the randomized dopamine trial (ClinicalTrials.gov identifier: NCT000115115) investigates the effects of spontaneous donor hypothermia (core body temperature <36°C) on initial kidney graft function, and evaluates 5‐year graft survival. Hypothermia assessed by a singular measurement in the intensive care unit 4‐20 hours before procurement was associated with less DGF after kidney transplantation (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.34‐0.91). The benefit was greater when need for more than a single posttransplant dialysis session was analyzed (OR 0.48, 95%CI 0.28‐0.82). Donor dopamine ameliorated dialysis requirement independently from hypothermia in a temporal relationship with exposure (OR 0.93, 95%CI 0.87‐0.98, per hour). A lower core body temperature in the donor was associated with lower serum creatinine levels before procurement, which may reflect lower systemic inflammation and attenuated renal injury from brain death. Despite a considerable effect on DGF, our study failed to demonstrate a graft survival advantage (hazard ratio [HR] 0.83, 95%CI 0.54‐1.27), whereas dopamine treatment was associated with improved long‐term outcome (HR 0.95, 95%CI 0.91‐0.99 per hour).
This retrospective multi‐center cohort study indicates that spontaneous hypothermia in the brain dead donor is associated with less delayed graft function, but fails to demonstrate a graft survival advantage after kidney transplantation.