DCD Donor Hemodynamics as Predictor of Outcome After Kidney Transplantation

H. Peters-Sengers, J. H. E. Houtzager, M. B. A. Heemskerk, M. M. Idu, R. C. Minnee, R. W. Klaasen, S. E. Joor, J. A. M. Hagenaars, P. M. Rebers, J. J. Homan van der Heide, J. I. Roodnat, F. J. Bemelman

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Abstract

Insufficient hemodynamics during agonal phase-i.e. the period between withdrawal of life-sustaining treatment and circulatory arrest-in Maastricht category III circulatory-death donors (DCD) potentially exacerbate ischemia/reperfusion injury. We included 409 Dutch adult recipients of DCD donor kidneys transplanted between 2006 and 2014. Peripheral oxygen saturation (SpO2-with pulse oximetry at the fingertip) and systolic blood pressure (SBP-with arterial catheter) were measured during agonal phase, and were dichotomized into minutes of SpO2>60% or SpO2 <60%, and minutes of SBP>80 mmHg or SBP <80 mmHg. Outcome measures were and primary non-function (PNF), delayed graft function (DGF), and 3-year graft survival. Primary non-function (PNF) rate was 6.6%, delayed graft function (DGF) rate was 67%, and graft survival at 3 years was 76%. Longer periods of agonal phase (median 16 min (IQR 11-23)) contributed significantly to an increased risk of DGF (p=.012), but not to PNF (P=.071) and graft failure (p=.528). Multiple logistic regression analysis showed that an increase from 7 to 20 minutes in period of SBP <80mmHg was associated with 2.19 times the odds (95%CI 1.08-4.46, p=0.030) for DGF. In conclusion, duration of agonal phase is associated with early transplant outcome. SBP <80mmHg during agonal phase shows a better discrimination for transplant outcome than SpO2 <60% does. This article is protected by copyright. All rights reserved
Original languageEnglish
Pages (from-to)1966-1976
JournalAmerican Journal of Transplantation
Volume18
Issue number8
DOIs
Publication statusPublished - 2018

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