title: Addition of direct peritoneal lavage to human cadaver organ donor resuscitation improves organ procurement.
abstract: BACKGROUND
  Brain dead organ donors have altered central hemodynamic performance, impaired hormone physiology, exaggerated systemic inflammatory response, end-organ microcirculatory dysfunction, and tissue hypoxia. A new treatment, direct peritoneal resuscitation (DPR), stabilizes vital organ blood flow after conventionally resuscitated shock to improve these derangements.
  
  
  METHODS
  A prospective case-control study of adjunctive DPR compared 26 experimental patients (brain dead organ donors) to 52 controls (protocolized conventionally resuscitated donors). Actual organ procurement rates were compared with the Scientific Registry of Transplant Recipient predicted organ yield per patient. Achievement of donor management goals and effective hepatic blood flow were recorded.
  
  
  RESULTS
  Fourteen of 26 (53.8%) patients treated with DPR achieved all donor management goals compared with 17 of 52 (32.7%) patients treated with conventionally resuscitated (odds ratio = 2.4; 95% CI, 0.92-6.3; p = 0.06). Patients treated with DPR were more than 2 times as likely to achieve final pO2 >100 on 40% FiO2 compared with controls (odds ratio = 2.8; 95% CI, 1-7.69; p = 0.03). Also, DPR-treated patients required less IV crystalloid during the first 12 hours of management (DPR: 3,167 ± 1,893 mL vs 4,154 ± 2,100 mL; p = 0.046) and required less vasopressor agents at 12 hours post resuscitation (odds ratio = 7.7; 95% CI, 0.82-42; p = 0.02). Direct peritoneal resuscitation patients had enhanced effective hepatic blood flow and significantly higher organs transplanted per donor rates compared with controls (3.7 ± 1.7 vs 3.1 ± 1.3; p = 0.024).
  
  
  CONCLUSIONS
  Direct peritoneal resuscitation reduced IV fluid requirement and IV pressor use as well as increased hepatic blood flow and organs transplanted per donor. Direct peritoneal resuscitation studies show it to be a safe, effective method to augment organ donor resuscitation and additional large-scale trials should be conducted to validate these findings.
authors: Department of Surgery, University of Louisville, Louisville, KY; Department of Physiology and Biophysics, University of Louisville, Louisville, KY. Electronic address: jasonw.smith@louisville.edu.
authors: Jason W
authors: JW
authors: Smith
authors: Department of Surgery, University of Louisville, Louisville, KY; Department of Physiology and Biophysics, University of Louisville, Louisville, KY; Louisville Veterans Affairs Medical Center, Louisville, KY.
authors: Paul J
authors: PJ
authors: Matheson
authors: Kentucky Organ Donor Affiliates, Louisville, KY.
authors: Gary
authors: G
authors: Morgan
authors: Department of Surgery, University of Louisville, Louisville, KY.
authors: Amy
authors: A
authors: Matheson
authors: Department of Surgery, University of Louisville, Louisville, KY.
authors: Cynthia
authors: C
authors: Downard
authors: Department of Surgery, University of Louisville, Louisville, KY; Louisville Veterans Affairs Medical Center, Louisville, KY; Kentucky Organ Donor Affiliates, Louisville, KY.
authors: Glen A
authors: GA
authors: Franklin
authors: Department of Surgery, University of Louisville, Louisville, KY; Department of Physiology and Biophysics, University of Louisville, Louisville, KY; Kentucky Organ Donor Affiliates, Louisville, KY.
authors: R Neal
authors: RN
authors: Garrison
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001926:Brain Death; D002102:Cadaver; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D010533:Peritoneal Lavage / Q000379:methods*; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods*; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000592:standards*; D055815:Young Adult