title: Donors with cardiac arrest: improved organ recovery but no preconditioning benefit in liver allografts.
abstract: BACKGROUND
  Historically, organ recovery rates in donors with cardiac arrest (CA) have been low, presumably from hemodynamic instability. We hypothesized that donor resuscitation has improved hemodynamic stability and organ recovery in CA donors, and that CA triggers ischemic preconditioning (IP) in liver grafts.
  
  
  METHODS
  A total of 131 donor pairs with and without CA were matched in age, gender, and year of recovery. Hemodynamic stability was determined by vasopressor use. Abdominal and thoracic organs recovered and livers transplanted were compared between the groups. Liver graft function, injury, and IP benefit were examined by comparing liver chemistries after transplantation and postperfusion biopsies between recipients of grafts from both groups (n=40 each).
  
  
  RESULTS
  Hemodynamic stability was similar in both groups, but recovery of thoracic organs was significantly lower in CA versus non-CA donors (35 vs. 53%, P<0.01). On the other hand, recovery rates of three or more abdominal organs from CA donors approached those of non-CA donors (77 vs. 87%, not significant). Although significantly fewer livers were transplanted from CA donors (69 vs. 85%, P<0.01), posttransplantation graft function and injury parameters were similar between the two groups, and CA did not appear to trigger IP.
  
  
  CONCLUSIONS
  Compared with historical data, cardiovascular stability and abdominal organ recovery rates have improved considerably in CA donors. Liver grafts from CA donors function similarly to grafts from non-CA donors with no IP from CA. Our data support the increased use of livers and other organs from donors with CA.
authors.affiliation: Department of Surgery, New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Dorian J
authors.initials: DJ
authors.lastname: Wilson
authors.forename: Adrian
authors.initials: A
authors.lastname: Fisher
authors.forename: Kasturi
authors.initials: K
authors.lastname: Das
authors.forename: Fred
authors.initials: F
authors.lastname: Goerlitz
authors.forename: Bart K
authors.initials: BK
authors.lastname: Holland
authors.forename: Andrew N
authors.initials: AN
authors.lastname: De La Torre
authors.forename: Anand
authors.initials: A
authors.lastname: Merchant
authors.forename: Joseph
authors.initials: J
authors.lastname: Seguel
authors.forename: Arun K
authors.initials: AK
authors.lastname: Samanta
authors.forename: Baburao
authors.initials: B
authors.lastname: Koneru
mesh_terms: D000005:Abdomen / Q000601:surgery; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006323:Heart Arrest; D006439:Hemodynamics; D006801:Humans; D019194:Ischemic Preconditioning; D008099:Liver / Q000503:physiopathology; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting; D014184:Transplantation, Homologous