title: Donor Hemodynamics as a Predictor of Outcomes After Kidney Transplantation From Donors After Cardiac Death.
abstract: Donation after cardiac death is an important source of transplantable organs, but evidence suggests donor warm ischemia contributes to inferior outcomes. Attempts to predict recipient outcome using donor hemodynamic measurements have not yielded statistically significant results. We evaluated novel measures of donor hemodynamics as predictors of delayed graft function and graft failure in a cohort of 1050 kidneys from 566 donors. Hemodynamics were described using regression line slopes, areas under the curve, and time beyond thresholds for systolic blood pressure, oxygen saturation, and shock index (heart rate divided by systolic blood pressure). A logistic generalized estimation equation model showed that area under the curve for systolic blood pressure was predictive of delayed graft function (above median: odds ratio 1.42, 95% confidence interval [CI] 1.06-1.90). Multivariable Cox regression demonstrated that slope of oxygen saturation during the first 10 minutes after extubation was associated with graft failure (below median: hazard ratio 1.30, 95% CI 1.03-1.64), with 5-year graft survival of 70.0% (95%CI 64.5%-74.8%) for donors above the median versus 61.4% (95%CI 55.5%-66.7%) for those below the median. Among older donors, increased shock index slope was associated with increased hazard of graft failure. Validation of these findings is necessary to determine the utility of characterizing donor warm ischemia to predict recipient outcome.
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: M B
authors.initials: MB
authors.lastname: Allen
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors.forename: E
authors.initials: E
authors.lastname: Billig
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.|Renal Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: P P
authors.initials: PP
authors.lastname: Reese
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors.forename: J
authors.initials: J
authors.lastname: Shults
authors.affiliation: Gift of Life Donor Program, Philadelphia, PA.
authors.forename: R
authors.initials: R
authors.lastname: Hasz
authors.affiliation: Gift of Life Donor Program, Philadelphia, PA.
authors.forename: S
authors.initials: S
authors.lastname: West
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.|Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: P L
authors.initials: PL
authors.lastname: Abt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003643:Death; D051799:Delayed Graft Function / Q000209:etiology / Q000401:mortality*; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007674:Kidney Diseases / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D052096:Warm Ischemia; D055815:Young Adult
keywords: delayed graft function (DGF); donors and donation: donation after circulatory death (DCD); graft survival; health services and outcomes research; kidney (allograft) function /dysfunction; kidney transplantation / nephrology; risk assessment / risk stratification