Effect of Brain-Dead Donor Resuscitation on Delayed Graft Function: Results of a Monocentric Analysis

Abstract

Our study shows an impact for only a limited number of brain dead donor resuscitation parameters on DGF duration. We also show that CIT has a much lower threshold (<16 hr) for DGF risk than previously described. Importantly, we show that recipient age is clearly a major independent risk factor for prolonged DGF, whereas donor age seems to act mostly as a dependent risk factor.

The Impact of Meeting Donor Management Goals on the Development of Delayed Graft Function in Kidney Transplant Recipients

“…Although a number of previous reports have tried to assess the impact of donor management on recipient kidney graft function (11,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), none of these studies have attempted to standardize donor management on a regional level or evaluate the impact of the prospective implementation of a DMG checklist on DGF. In the current investigation, the impact of meeting such a checklist of DMGs on graft outcomes in deceased donor kidney recipients was prospectively investigated.…”

Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients

“…One subsequent meta-analysis suggested a trend towards increased mortality after HES in comparison with alternative resuscitation fluids in trials that included patients with severe sepsis and septic shock, in high-quality and multicentre trials [30]. [68] Cohort study Plasmapheresis Plasma chitotriosidase activity (marker for lysosomal storage) Avorn [46] Case-control study Coronary artery bypass surgery Effect of 6% HES 450/0.7 on postoperative bleeding Bayer [92] Before-and-after cohort study Severe sepsis Effect of predominantly HES 130/0.4, 4% gelatin and only crystalloids on renal function Boussekey [71] Cohort Predefined subgroup analysis Severe sepsis Effect of 4% albumin versus 0.9% saline on 28-day mortality Ginz [69] Case report ICU patient Autopsy Giral [55] Cohort study Brain-dead organ donors Kidney graft function after HES Gondos [93] Multicentre Safety: Medium and high molecular weight HES preparations in cumulative doses below 20 mL/kg were associated with increased postoperative bleeding in cardiac surgical patients compared with albumin [pooled standardized mean difference, 0.24 (95% CI -0.40, -0.08)] [44]. Two cohort studies found increased bleeding or chest tube drainage after use of HES in cardiac surgery [45,46].…”

“…Graft function: In 1996, one RCT found that more kidney transplant recipients required RRT in the first 8 days if they had received organs from donors after resuscitation with 6% HES 200/0.6 than if donors had been resuscitated with only 3% gelatin [27 (33%) versus 20 (5%), p = 0.029] [53]. Subsequent non-randomized cohort studies confirmed that HES was a risk factor for delayed graft function in these patients [54,55] or found no difference in comparison with fluid therapy with only crystalloids or other colloids [56,57]. A recent RCT which compared 4% gelatin or HES 130/0.4 for resuscitation of 77 living donors found no difference in urine output within 4 days after surgery [58].…”

Expression of BMP-2 in Vascular Endothelial Cells of Recipient May Predict Delayed Graft Function After Renal Transplantation

“…Maintenance dialysis vintage prior to transplant was found to be perhaps the most important contributor [27], followed by obesity and diabetes [28,29]. Male patients, older than 55 years, of African-American race, with prolonged waiting-time period, sensitized and those who received small-for-size organs all have increased risk for DGF [3,4,[30][31][32].…”