Vasopressor selection during critical care management of brain dead organ donors and the effects on kidney graft function

Elizabeth A. Swanson, Madhukar S. Patel, Tahnee Groat, Nora E. Jameson, Margaret K.M. Ellis, Michael P. Hutchens, Claus U. Niemann, Darren J. Malinoski, Mitchell B. Sally

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

BACKGROUND Delayed graft function (DGF), the need for dialysis in the first week following kidney transplant, affects approximately one quarter of deceased-donor kidney transplant recipients. Donor demographics, donor serum creatinine, and graft cold ischemia time are associated with DGF. However, there is no consensus on the optimal management of hemodynamic instability in organ donors after brain death (DBDs). Our objective was to determine the relationship between vasopressor selection during donor management and the development of DGF. METHODS Prospective observational data, including demographic and critical care parameters, were collected for all DBDs managed by 17 organ procurement organizations from nine Organ Procurement and Transplantation Network Regions between 2012 and 2018. Recipient outcome data were linked with donor data through donor identification numbers. Donor critical care parameters, including type of vasopressor and doses, were recorded at three standardized time points during donor management. The analysis included only donors who received at least one vasopressor at all three time points. Vasopressor doses were converted to norepinephrine equivalent doses and analyzed as continuous variables. Univariate analyses were conducted to determine the association between donor variables and DGF. Results were adjusted for known predictors of DGF using binary logistic regression. RESULTS Complete data were available for 5,554 kidney transplant recipients and 2,985 DBDs. On univariate analysis, donor serum creatinine, donor age, donor subtype, kidney donor profile index, graft cold ischemia time, phenylephrine dose, and dopamine dose were associated with DGF. After multivariable analysis, increased donor serum creatinine, donor age, kidney donor profile index, graft cold ischemia time, and phenylephrine dose remained independent predictors of DGF. CONCLUSION Higher doses of phenylephrine were an independent predictor of DGF. With the exception of phenylephrine, the selection and dose of vasopressor during donor management did not predict the development of DGF. LEVEL OF EVIDENCE Prognostic study, Level III.

Original languageEnglish (US)
Pages (from-to)783-788
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume88
Issue number6
DOIs
StatePublished - Jun 1 2020

Keywords

  • Organ donor management
  • brain death
  • delayed gzraft function
  • kidney transplant
  • vasopressor

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Fingerprint

Dive into the research topics of 'Vasopressor selection during critical care management of brain dead organ donors and the effects on kidney graft function'. Together they form a unique fingerprint.

Cite this