Donor postextubation hypotension and age correlate with outcome after donation after cardiac death transplantation.
BACKGROUND
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.


METHODS
We performed a retrospective examination of the New England Organ Bank DCD database, concentrating on donor factors including vital signs after withdrawal of support.


RESULTS
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.


CONCLUSIONS
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.
Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Karen J
KJ
Ho
Christopher D
CD
Owens
Scott R
SR
Johnson
Khalid
K
Khwaja
Michael P
MP
Curry
Martha
M
Pavlakis
Didier
D
Mandelbrot
James J
JJ
Pomposelli
Shimul A
SA
Shah
Reza F
RF
Saidi
Dicken S C
DS
Ko
Sayeed
S
Malek
John
J
Belcher
David
D
Hull
Stefan G
SG
Tullius
Richard B
RB
Freeman
Elizabeth A
EA
Pomfret
James F
JF
Whiting
Douglas W
DW
Hanto
Seth J
SJ
Karp
D000328:Adult; D000367:Age Factors; D001794:Blood Pressure / Q000502:physiology; D003643:Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007022:Hypotension / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D015994:Incidence; D007442:Intubation, Intratracheal; D016030:Kidney Transplantation / Q000379:methods / Q000502:physiology*; D016031:Liver Transplantation / Q000379:methods / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D014481:United States / Q000453:epidemiology; D015300:Ventilator Weaning / Q000009:adverse effects*