title: The impact of meeting donor management goals on the development of delayed graft function in kidney transplant recipients.
abstract: Many organ procurement organizations (OPOs) utilize preset critical care endpoints as donor management goals (DMGs) in order to standardize care and improve outcomes. The objective of this study was to determine the impact of meeting DMGs on delayed graft function (DGF) in renal transplant recipients. All eight OPOs of the United Network for Organ Sharing Region 5 prospectively implemented nine DMGs in every donor after neurologic determination of death (DNDD). "DMGs met" was defined a priori as achieving any seven of the nine DMGs and this was recorded at the time of consent for donation to reflect donor hospital ICU management, 12-18 h later, and prior to organ recovery. Multivariable analyses were performed to identify independent predictors of DGF (dialysis in the first week after transplantation) with a p<0.05. A total of 722 transplanted kidneys from 492 DNDDs were included. A total of 28% developed DGF. DMGs were met at consent in 14%, 12-18 h in 32% and prior to recovery in 38%. DGF was less common when DMGs were met at consent (17% vs. 30%, p=0.007). Independent predictors of DGF were age, Cr and cold ischemia time, while meeting DMGs at consent was significantly protective. The management of potential organ donors prior to consent affects outcomes and should remain a priority in the intensive care unit.
authors: Surgical Critical Care Section, Portland Veterans Affairs Medical Center, Portland, OR.
authors: D J
authors: DJ
authors: Malinoski
authors: Department of Surgery, Massachusetts General Hospital, Boston, MA.
authors: M S
authors: MS
authors: Patel
authors: Division of Transplantation Surgery, University of California Irvine, Orange, CA.
authors: O
authors: O
authors: Ahmed
authors: Division of Transplantation Surgery, University of California Irvine, Orange, CA.
authors: M C
authors: MC
authors: Daly
authors: Division of Transplantation Surgery, University of California Irvine, Orange, CA.
authors: S
authors: S
authors: Mooney
authors: United Network for Organ Sharing, Richmond, VA.
authors: C O
authors: CO
authors: Graybill
authors: Division of Transplantation Surgery, University of California Irvine, Orange, CA.
authors: C E
authors: CE
authors: Foster
authors: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
authors: A
authors: A
authors: Salim
mesh_terms: D000328:Adult; D001926:Brain Death; D003422:Critical Care / Q000379:methods; D051799:Delayed Graft Function; D006085:Graft Survival; D006801:Humans; D007362:Intensive Care Units; D016030:Kidney Transplantation / Q000592:standards*; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012306:Risk; D009927:Tissue and Organ Procurement / Q000592:standards*; D016896:Treatment Outcome; D055815:Young Adult