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

doi:https://doi.org/10.1111/ajt.14676

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

Research output: Contribution to journal › Article › Academic › peer-review

26 Citations (Scopus)

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 language	English
Pages (from-to)	1966-1976
Journal	American Journal of Transplantation
Volume	18
Issue number	8
DOIs	https://doi.org/10.1111/ajt.14676
Publication status	Published - 2018

Access to Document

https://doi.org/10.1111/ajt.14676

Cite this

Peters-Sengers, H., Houtzager, J. H. E., Heemskerk, M. B. A., Idu, M. M., Minnee, R. C., Klaasen, R. W., Joor, S. E., Hagenaars, J. A. M., Rebers, P. M., Homan van der Heide, J. J., Roodnat, J. I., & Bemelman, F. J. (2018). DCD Donor Hemodynamics as Predictor of Outcome After Kidney Transplantation. American Journal of Transplantation, 18(8), 1966-1976. https://doi.org/10.1111/ajt.14676

@article{f1ceb287935c4ee9959b390aea421daa,

title = "DCD Donor Hemodynamics as Predictor of Outcome After Kidney Transplantation",

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",

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

year = "2018",

doi = "https://doi.org/10.1111/ajt.14676",

language = "English",

volume = "18",

pages = "1966--1976",

journal = "American Journal of Transplantation",

issn = "1600-6135",

publisher = "Wiley-Blackwell",

number = "8",

}

TY - JOUR

T1 - DCD Donor Hemodynamics as Predictor of Outcome After Kidney Transplantation

AU - Peters-Sengers, H.

AU - Houtzager, J. H. E.

AU - Heemskerk, M. B. A.

AU - Idu, M. M.

AU - Minnee, R. C.

AU - Klaasen, R. W.

AU - Joor, S. E.

AU - Hagenaars, J. A. M.

AU - Rebers, P. M.

AU - Homan van der Heide, J. J.

AU - Roodnat, J. I.

AU - Bemelman, F. J.

PY - 2018

Y1 - 2018

N2 - 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

AB - 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

U2 - https://doi.org/10.1111/ajt.14676

DO - https://doi.org/10.1111/ajt.14676

M3 - Article

C2 - 29380523

SN - 1600-6135

VL - 18

SP - 1966

EP - 1976

JO - American Journal of Transplantation

JF - American Journal of Transplantation

IS - 8

ER -