title: Determining optimal threshold for glucose control in organ donors after neurologic determination of death: a United Network for Organ Sharing Region 5 Donor Management Goals Workgroup prospective analysis.
abstract: BACKGROUND
  The appropriate level of glucose control in organ donors after neurologic determination of death (DNDD) remains uncertain. We hypothesized that a glucose target of 180 mg/dL would be appropriate for optimizing organ transplantation rates and outcomes.
  
  
  METHODS
  Demographic, critical care, organ transplantation, and graft outcome data were prospectively collected on all DNDDs in United Network for Organ Sharing (UNOS) Region 5 from 2010 to 2012. Glucose levels were assessed at four time points in the organ donation process. The primary outcome measure was having four or more organs transplanted per donor (OTPD). Univariate analyses were conducted to determine the relationship between glucose levels and OTPD, organ transplantation rates, and graft function. Multivariate analyses were performed to determine independent predictors of four or more OTPDs. Glucose levels were analyzed at the following cutoff points: 150 or less, 180, and 200 mg/dL. Results with a p < 0.05 are listed.
  
  
  RESULTS
  A total of 1,611 DNDDs had a mean (SD) age of 38 (17) years and 3.4 (1.7) OTPDs. Forty-one percent had four or more OTPDs. Glucose levels of 150 mg/dL or less were not associated with differences in organ use. Levels of 180 mg/dL or less were associated with more OTPDs (3.5 vs. 3.2), a higher rate of four or more OTPDs (42% vs. 34%), and more heart (34% vs. 28%), pancreas (18% vs. 11%), and kidney (85% vs. 81%) use. Levels of 200 mg/dL or less revealed similar results. However, only a level of 180 mg/dL or less was an independent predictor of four or more OTPDs (odds ratio, 1.4). All three levels were associated with higher kidney graft survival after a mean (SD) of 10 (6.0) months of follow-up (97% vs. 95%).
  
  
  CONCLUSIONS
  Hyperglycemia is common in DNDDs and is associated with lower organ transplantation rates and worse graft outcomes. Targeting a glucose level of 180 mg/dL or less seems to preserve outcomes and is consistent with general critical care guidelines.
  
  
  METHODS
  Therapeutic study, level II.
authors.affiliation: From the Surgical Critical Care Section (M.B.S., M.C., S.D.L.C., J.Z., D.J.M.), Portland Veterans Affairs Medical Center; and Department of Surgery (M.B.S., S.D.L.C., J.Z., D.J.M.), Oregon Health and Science University, Portland, Oregon; University of California-Davis School of Medicine (T.E.), Sacramento, California; Department of Surgery (M.S.P.), Massachusetts General Hospital, Boston, Massachusetts; and Department of Surgery (S.R.), Temple University, Philadelphia, Pennsylvania.
authors.forename: Mitchell B
authors.initials: MB
authors.lastname: Sally
authors.forename: Tyler
authors.initials: T
authors.lastname: Ewing
authors.forename: Megan
authors.initials: M
authors.lastname: Crutchfield
authors.forename: Madhukar S
authors.initials: MS
authors.lastname: Patel
authors.forename: Shariq
authors.initials: S
authors.lastname: Raza
authors.forename: Salvador
authors.initials: S
authors.lastname: De La Cruz
authors.forename: John
authors.initials: J
authors.lastname: Zatarain
authors.forename: Darren Jay
authors.initials: DJ
authors.lastname: Malinoski
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D001926:Brain Death / Q000378:metabolism*; D004493:Education; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006085:Graft Survival; D006801:Humans; D008297:Male; D016377:Organ Transplantation / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D009927:Tissue and Organ Procurement / Q000379:methods / Q000458:organization & administration* / Q000592:standards; D014481:United States
chemical_list: D001786:Blood Glucose; D005947:Glucose