Influence of the hemodynamic status of multiorgan donors on long-term kidney graft survival--a multivariable analysis.
BACKGROUND
The quality of transplanted organ and timing of the initiation of its effective function depends on many factors potentially causing graft dysfunction. The aim of this study was to evaluate the influence of the cardiovascular status of multiorgan donors on the long-term kidney graft survival over a 15-year observation period.


METHODS
In 2007, the authors of this study published a multicenter prospective study evaluating the influence of the hemodynamic status of multiorgan donors on the early function of transplanted kidney. The results of that study showed that mean arterial pressure, central venous pressure, and pulmonary capillary wedge pressure values of the donor importantly influence the frequency of delayed graft function after renal transplantation. The present analysis covers the effect of the donor's hemodynamic status parameters on graft function time within the 15-year observation period. Univariate and multivariate analyses using the Cox regression proportional hazard model were performed to evaluate the prognostic parameters for overall survival and renal graft survival time. P < .05 was considered to be significant.


RESULTS
The univariate analysis showed a significantly shorter time of graft survival in the group of recipients who had a kidney retrieved from donors with lower pulmonary capillary wedge pressure values (P = .038) and lower cardiac index values (P = .039). The same results were obtained for the multifactorial Cox logistic regression analysis.


CONCLUSIONS
The filling of the intravascular bed of the donor as determined by pulmonary capillary wedge pressure and maintained donor tissue perfusion as determined by cardiac index, impose important factors influencing long-term kidney graft survival.
Department of Anesthesiology, Intensive Care and Acute Poisoning, Pomeranian Medical University, Szczecin, Poland.
K
K
Kotfis
Department of Laboratory Diagnostic and Molecular Medicine, Pomeranian Medical University, Szczecin, Poland.
M
M
Kaczmarczyk
Department of Anesthesiology, Intensive Care and Acute Poisoning, Pomeranian Medical University, Szczecin, Poland.
J
J
Biernawska
Department of Anesthesiology, Intensive Care and Acute Poisoning, Pomeranian Medical University, Szczecin, Poland.
L
L
Szydłowski
Clinical Microbiology, Teaching Hospital No 2, Pomeranian Medical University, Szczecin, Poland.
A
A
Zukowska
Department of Anesthesiology, Intensive Care and Acute Poisoning, Pomeranian Medical University, Szczecin, Poland.
K
K
Szliżewska
Department of Anesthesiology, Intensive Care and Acute Poisoning, Pomeranian Medical University, Szczecin, Poland.
M
M
Zegan-Barańska
Clinic of Anesthesiology and Intensive Care, Pomeranian Medical University, Szczecin, Poland.
R
R
Bohatyrewicz
Department of Anesthesiology, Intensive Care and Acute Poisoning, Pomeranian Medical University, Szczecin, Poland. Electronic address: zukowski@sci.pam.szczecin.pl.
M
M
Zukowski
D000328:Adult; D002496:Central Venous Pressure; D005260:Female; D006085:Graft Survival; D006439:Hemodynamics; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010477:Perfusion; D011379:Prognosis; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure; D014019:Tissue Donors; D055815:Young Adult