Organ donor management goals and delayed graft function in adult kidney transplant recipients

Kothari, Rishi; Tolles, Juliana; Adelmann, Dieter; Lewis, Roger J.; Malinoski, Darren; Niemann, Claus U.

doi:10.1111/ctr.14528

Cited by 6 publications

(5 citation statements)

References 39 publications

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“…Kothari et al performed a retrospective case-control study to examine which DMGs are associated with a decreased incidence of DGF. 52 After examining 14 046 cases, they found that meeting DMGs of ≤1 vasopressor (OR .77, 95% CI 0.62-.94; P = .012) and urine output ≥.5 mL/kg/hr (OR .72, 95% CI 0.63-.85; P < .001) were associated with a decreased incidence of DGF. In contrast, meeting a DMG for serum sodium ≤155 mEq/L was associated with an increased incidence of DGF (OR 1.22, 95% CI 1.04-1.42; P = .014).…”

Section: Donor Management Goalsmentioning

confidence: 99%

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Abdominal Organ Transplantation: Noteworthy Literature in 2022

Nolasco

Igwe

Sakai

2023

Semin Cardiothorac Vasc Anesth

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This review highlights noteworthy literature published in 2022 pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We begin by exploring the impacts that the COVID-19 pandemic has had across the field of abdominal organ transplantation, including the successful use of grafts procured from COVID-19-infected donors. In pancreatic transplantation, we highlight several studies on dexmedetomidine and ischemia-reperfusion injury, equity in transplantation, and medical management, as well as studies comparing pancreatic transplantation to islet cell transplantation. In our section on intestinal transplantation, we explore donor selection. Kidney transplantation topics include cardiovascular risk management, obesity, and intraoperative management, including fluid resuscitation, dexmedetomidine, and sugammadex. The liver transplantation section focuses on clinical trials, systematic reviews, and meta-analyses published in 2022 and covers a wide range of topics, including machine perfusion, cardiovascular issues, renal issues, and coagulation/transfusion.

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Section: Donor Management Goalsmentioning

confidence: 99%

“…In contrast, meeting a DMG for serum sodium ≤155 mEq/L was associated with an increased incidence of DGF (OR 1.22, 95% CI 1.04-1.42; P = .014). 52 More research is needed to help further determine optimal DMG targets, as causal relationships cannot be inferred in retrospective trials.…”

Section: Donor Management Goalsmentioning

confidence: 99%

Abdominal Organ Transplantation: Noteworthy Literature in 2022

Nolasco

Igwe

Sakai

2023

Semin Cardiothorac Vasc Anesth

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“…Goal-directed checklists have been found to improve the quality of care and consequently the conversion of brain-dead potential donors to actual organ donors, 8,9,11 the number of organs transplanted per donor, [12][13][14][15] and posttransplant graft function. 16,17 Given the observational nature of these findings and the variability of their protocols for deceased donor care, clinicians and researchers have called for randomized trials to confirm the results. 16,18 The Donation Network to Optimize Organ Recovery Study (DONORS) was a cluster randomized trial designed to evaluate the effectiveness of an evidence-based, goal-directed checklist in the clinical management of brain-dead potential donors in the intensive care unit (ICU).…”

Section: Introductionmentioning

confidence: 99%

“…Goal-directed checklists have been found to improve the quality of care and consequently the conversion of brain-dead potential donors to actual organ donors, the number of organs transplanted per donor, and posttransplant graft function . Given the observational nature of these findings and the variability of their protocols for deceased donor care, clinicians and researchers have called for randomized trials to confirm the results .…”

Section: Introductionmentioning

confidence: 99%

Evidence-Based Checklist to Delay Cardiac Arrest in Brain-Dead Potential Organ Donors

Westphal,

Robinson,

Giordani

et al. 2023

JAMA Netw Open

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ImportanceThe effectiveness of goal-directed care to reduce loss of brain-dead potential donors to cardiac arrest is unclear.ObjectiveTo evaluate the effectiveness of an evidence-based, goal-directed checklist in the clinical management of brain-dead potential donors in the intensive care unit (ICU).Design, Setting, and ParticipantsThe Donation Network to Optimize Organ Recovery Study (DONORS) was an open-label, parallel-group cluster randomized clinical trial in Brazil. Enrollment and follow-up were conducted from June 20, 2017, to November 30, 2019. Hospital ICUs that reported 10 or more brain deaths in the previous 2 years were included. Consecutive brain-dead potential donors in the ICU aged 14 to 90 years with a condition consistent with brain death after the first clinical examination were enrolled. Participants were randomized to either the intervention group or the control group. The intention-to-treat data analysis was conducted from June 15 to August 30, 2020.InterventionsHospital staff in the intervention group were instructed to administer to brain-dead potential donors in the intervention group an evidence-based checklist with 13 clinical goals and 14 corresponding actions to guide care, every 6 hours, from study enrollment to organ retrieval. The control group provided or received usual care.Main Outcomes and MeasuresThe primary outcome was loss of brain-dead potential donors to cardiac arrest at the individual level. A prespecified sensitivity analysis assessed the effect of adherence to the checklist in the intervention group.ResultsAmong the 1771 brain-dead potential donors screened in 63 hospitals, 1535 were included. These patients included 673 males (59.2%) and had a median (IQR) age of 51 (36.3-62.0) years. The main cause of brain injury was stroke (877 [57.1%]), followed by trauma (485 [31.6%]). Of the 63 hospitals, 31 (49.2%) were assigned to the intervention group (743 [48.4%] brain-dead potential donors) and 32 (50.8%) to the control group (792 [51.6%] brain-dead potential donors). Seventy potential donors (9.4%) at intervention hospitals and 117 (14.8%) at control hospitals met the primary outcome (risk ratio [RR], 0.70; 95% CI, 0.46-1.08; P = .11). The primary outcome rate was lower in those with adherence higher than 79.0% than in the control group (5.3% vs 14.8%; RR, 0.41; 95% CI, 0.22-0.78; P = .006).Conclusions and RelevanceThis cluster randomized clinical trial was inconclusive in determining whether the overall use of an evidence-based, goal-directed checklist reduced brain-dead potential donor loss to cardiac arrest. The findings suggest that use of such a checklist has limited effectiveness without adherence to the actions recommended in this checklist.Trial RegistrationClinicalTrials.gov Identifier: NCT03179020

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“…Donor management goals, which are standards of care or clinical parameters, have been considered an acceptable barometer of successful donor management[ 9 , 10 ]. Meeting donor management goals has been associated with an increased number of retrieved organs per donor[ 1 , 11 - 13 ] and, more recently, a reduced incidence of delayed graft function[ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Haemodynamic management in brain death donors: Influence of aetiology of brain death

Lazzeri¹,

Bonizzoli²,

Batacchi³

et al. 2023

World J Transplant

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BACKGROUND In brain death donors (BDDs), donor management is the key in the complex donation process. Donor management goals, which are standards of care or clinical parameters, have been considered an acceptable barometer of successful donor management. AIM To test the hypothesis that aetiology of brain death could influence haemody namic management in BDDs. METHODS Haemodynamic data (blood pressure, heart rate, central venous pressure, lactate, urine output, and vasoactive drugs) of BDDs were recorded on intensive care unit (ICU) admission and during the 6-h observation period (Time 1 at the beginning; Time 2 at the end). RESULTS The study population was divided into three groups according to the aetiology of brain death: Stroke ( n = 71), traumatic brain injury ( n = 48), and postanoxic encephalopathy ( n = 19). On ICU admission, BDDs with postanoxic encephalopathy showed the lowest values of systolic and diastolic blood pressure associated with higher values of heart rate and lactate and a higher need of norepinephrine and other vasoactive drugs. At the beginning of the 6-h period (Time 1), BDDs with postanoxic encephalopathy showed higher values of heart rate, lactate, and central venous pressure together with a higher need of other vasoactive drugs. CONCLUSION According to our data, haemodynamic management of BDDs is affected by the aetiology of brain death. BDDs with postanoxic encephalopathy have higher requirements for norepinephrine and other vasoactive drugs.

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Organ donor management goals and delayed graft function in adult kidney transplant recipients

Cited by 6 publications

References 39 publications

Abdominal Organ Transplantation: Noteworthy Literature in 2022

Abdominal Organ Transplantation: Noteworthy Literature in 2022

Evidence-Based Checklist to Delay Cardiac Arrest in Brain-Dead Potential Organ Donors

Haemodynamic management in brain death donors: Influence of aetiology of brain death

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