Effect of Cardiac Arrest in Brain-dead Donors on Kidney Graft Function

Abstract

Background. Cardiac arrest (CA) causes renal ischemia in one-third of brain-dead kidney donors before procurement. We hypothesized that the graft function depends on the time interval between CA and organ procurement. Methods. We conducted a retrospective population-based study on a prospectively curated database. We included 1469 kidney transplantations from donors with a history of resuscitated CA in 2015–2017 in France. CA was the cause of death (primary CA) or an intercurrent event (secondary CA). The main outcome was the percentage of delayed graft function, defined by the use of renal replacement therapy within the first week posttransplantation. Results. Delayed graft function occurred in 31.7% of kidney transplantations and was associated with donor function, vasopressors, cardiovascular history, donor and recipient age, body mass index, cold ischemia time, and time to procurement after primary cardiac arrest. Short cold ischemia time, perfusion device use, and the absence of cardiovascular comorbidities were protected by multivariate analysis, whereas time <3 d from primary CA to procurement was associated with delayed graft function (odds ratio 1.38). Conclusions. This is the first description of time to procurement after a primary CA as a risk factor for delayed graft function. Delaying procurement after CA should be evaluated in interventional studies.

Donor Resuscitation Time, Kidney Transplant, and Selection Bias: Les reins ont des raisons que la raison ne connaît pas (with Apologies to Blaise Pascal)

“…10 On appearances, the present study seems to contradict that. However, consistent with the hypothesis that reversible injury is reversible, Dubourg et al 9 found that donors with arrests associated with underlying cardiovascular disease-a patient population with a higher incidence of kidney disease 11 were more likely to result in recipient DGF. Additionally, as has been repeatedly shown, pumping the kidneys resulted in less DGF-likely resulting in both physiological changes such as vasodilation and selection bias for kidneys that demonstrate better pump parameters.…”

“…In this issue, Dubourg et al utilize data from the national CRISTAL registry of the French Agence de la biomédecine to hone down on data from a subset of such donors. 9 They analyzed 1469 kidney transplant patients from brain-dead donors with resuscitated cardiac arrest as the cause of death or as an intercurrent event and found that kidney recipients from donors with a <3-d interval between cardiac arrest and organ recovery were more likely to suffer from delayed graft function (DGF), whereas short cold ischemia times, machine perfusion storage, and the absence of cardiac comorbidities were protective. These data suggest that the additional interval time allows for better resuscitation of the donors, with the potential impact of the decreased DGF resulting in better allograft survival.…”