title: Impact of deceased organ donor demographics and critical care end points on liver transplantation and graft survival rates.
abstract: BACKGROUND
  The criteria for organ acceptance remain inconsistent, which limits the ability to standardize critical care practices. We sought to examine predictors of liver graft use and survival to better guide the selection and management of potential organ donors.
  
  
  METHODS
  A prospective observational study of all donors managed by the 8 organ procurement organizations in United Network for Organ Sharing Region 5 was conducted from July 2008 to March 2011. Critical care end points that reflect the normal hemodynamic, acid-base, respiratory, endocrine, and renal status of the donor were collected at 3 time points. Critical care and demographic data associated with liver transplantation and graft survival rates were first determined using univariate analyses, and then logistic regression was used to identify independent predictors of these two outcomes.
  
  
  RESULTS
  From 961 donors, 730 (76%) livers were transplanted and 694 (95%) were functioning after 74 ± 73 days of follow-up. After regression analysis, donor BMI (odds ratio [OR] = 0.94), male sex (OR = 1.89), glucose <150 mg/dL (OR = 1.97), lower dopamine dose (OR = 0.95), vasopressin use (OR = 1.95), and ejection fraction >50% (OR = 1.77) remained as independent predictors of liver use. Graft survival was associated with lower donor BMI (OR = 0.91) and sodium levels (OR = 0.95).
  
  
  CONCLUSIONS
  After controlling for donor age, sex, and BMI, both hemodynamic and endocrine critical care end points were associated with increased liver graft use. Both donor BMI and lower sodium levels during the course of donor management were independently predictive of improved graft survival. These results may help guide the management and selection of potential organ donors after neurologic determination of death.
authors.affiliation: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Bloom
authors.affiliation: Department of Surgery, Temple University Medical Center, Philadelphia, PA.
authors.forename: Shariq
authors.initials: S
authors.lastname: Raza
authors.affiliation: Midwestern University, Glendale, AZ.
authors.forename: Akash
authors.initials: A
authors.lastname: Bhakta
authors.affiliation: School of Medicine, University of California, Davis, CA.
authors.forename: Tyler
authors.initials: T
authors.lastname: Ewing
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Madhukar
authors.initials: M
authors.lastname: Patel
authors.affiliation: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Ley
authors.affiliation: Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Margulies
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.affiliation: Surgical Critical Care Section, Portland Veterans Affairs Medical Center, Portland, OR; Department of Surgery, Oregon Health and Science University, Portland, OR. Electronic address: Darren.malinoski@va.gov.
authors.forename: Darren
authors.initials: D
authors.lastname: Malinoski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D046148:Donor Selection / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies