Vasopressor selection during critical care management of brain dead organ donors and the effects on kidney graft function
| Autor: | Mitchell B. Sally, Madhukar S. Patel, Margaret Katherine Ellis, Michael P. Hutchens, Elizabeth A. Swanson, Nora E. Jameson, Darren J. Malinoski, Tahnee Groat, Claus U. Niemann |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Brain Death medicine.medical_specialty Tissue and Organ Procurement Critical Care medicine.medical_treatment Urology Delayed Graft Function Kidney Critical Care and Intensive Care Medicine Risk Assessment Cold Ischemia Time Article Phenylephrine Young Adult 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine medicine Humans Vasoconstrictor Agents Prospective Studies Prospective cohort study Dialysis Univariate analysis Creatinine Dose-Response Relationship Drug business.industry Cold Ischemia Age Factors 030208 emergency & critical care medicine Middle Aged Kidney Transplantation Transplantation medicine.anatomical_structure chemistry Female Surgery business medicine.drug |
| Zdroj: | J Trauma Acute Care Surg |
| ISSN: | 2163-0763 2163-0755 |
| DOI: | 10.1097/ta.0000000000002688 |
| Popis: | 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 seventeen 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 |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|