Impact of donor cardiopulmonary resuscitation on the outcome of simultaneous pancreas–kidney transplantation—a retrospective study

Abstract

Previous cardiac arrest in brain-dead donors has been discussed as a potential risk factor in pancreas transplantation (PT), leading to a higher rate of organ refusal. This study aimed to assess the impact of cardiopulmonary resuscitation (CPR) in brain-dead donors on pancreas transplant outcome. A total of 518 type 1 diabetics underwent primary simultaneous pancreas-kidney (SPK) transplantation at our center between 1994 and 2018. Patients were divided into groups, depending on whether their donor had been resuscitated or not. A total of 91 (17.6%) post-CPR donors had been accepted for transplantation (mean duration of cardiac arrest, 19.4 AE 15.6 min). Those donors were younger (P < 0.001), had lower pancreas donor risk index (PDRI, P = 0.003), and had higher serum creatinine levels (P = 0.021). With a median follow-up of 167 months (IQR 82-229), both groups demonstrated comparable short-and long-term patient and graft survival. The resuscitation time (<20 min vs. ≥20 min) also showed no impact, with similar survival rates for both groups. A multivariable Cox regression analysis suggested no statistically significant association between donor CPR and patient or graft survival. Our results indicate that post-CPR brain-dead donors are suitable for PT without increasing the risk of complications.

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

“…12,13 Nonetheless, on average, resuscitated CA does not impair allograft function in the recipient. 8,11,[14][15][16][17][18] The favorable characteristics of these donors selected despite their history of CA might explain this result, as could the modification by other factors of the effects of ischemia in this situation. For example, experimental models show that a first ischemic episode can provide time-limited protection against a second injury, a phenomenon called ischemic preconditioning.…”

“…10 Donors' renal function decreases after a resuscitated CA. 8,11 Other causes of warm ischemia during kidney transplantation, for example, vascular anastomosis time, also lead to poorer functional results. 12,13 Nonetheless, on average, resuscitated CA does not impair allograft function in the recipient.…”

“…About one-third of donors have a history of resuscitated cardiac arrest (CA) before organ procurement. 7,8 This CA interrupts the blood flow and induces warm ischemia in the kidney. 9 It can occur at different times during donor care, corresponding to different situations with various consequences on the circulation in terms of no flow (complete circulatory arrest) or low flow (partial circulatory restoration by resuscitation maneuvers).…”