Organ donor management and delayed graft function in kidney transplant recipients: A multicenter retrospective cohort study

• Published in: American journal of transplantation Vol. 19; no. 1; pp. 277 - 284
• Main Authors: Cardinal, Heloise, Lamarche, Florence, Grondin, Stéphanie, Marsolais, Pierre, Lagacé, Anne‐Marie, Duca, Anatolie, Albert, Martin, Houde, Isabelle, Boucher, Anne, Masse, Mélanie, Baran, Dana, Bouchard, Josée
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.01.2019
• Subjects: Adult; clinical research/practice; Cohort analysis; critical care/intensive care management; delayed graft function (DGF); Delayed Graft Function - etiology; donation after brain death (DBD); donors and donation; Female; Graft Survival; Humans; Kidney transplantation; Kidney Transplantation - adverse effects; kidney transplantation/nephrology; Kidney transplants; Male; Middle Aged; Multivariate Analysis; Organ donors; Organ Preservation - adverse effects; organ procurement and allocation; Perfusion; Research Design; Retrospective Studies; Risk Factors; Tissue and Organ Procurement - methods; Tissue Donors; Transplant Recipients; donation after brain death (DBD); clinical research/practice; kidney transplantation/nephrology; organ procurement and allocation; delayed graft function (DGF); critical care/intensive care management; donors and donation
• ISSN: 1600-6135; 1600-6143; 1600-6143
• DOI: 10.1111/ajt.15127

Meeting donor management goals (DMGs) has been reported to decrease the incidence of delayed graft function (DGF) after kidney transplant, but whether this relationship is independent of cold machine perfusion is unclear. We aimed to determine whether meeting DMGs is associated with a reduced incidence of DGF, independent of the use of machine perfusion. We collected data on consecutive brain‐dead donors and their KT recipients (KTRs) between June 2013 and December 2016 in 5 adult transplant centers. We evaluated whether DMGs were met at donor neurologic death (DND) and later time points. We defined a priori meeting optimal DMG as achieving ≥7 DMGs. Generalized estimating equations were used to predict DGF. Among 122 donors, 34% were extended‐criteria donors (ECDs). The number of DMGs met increased over time (5.6 ± 1.4 at DND and 6.1 ± 1.3 at organ procurement [P < .001]). DGF occurred in 23% of 214 KTRs, and 55% received organs placed on machine perfusion. In multivariate analysis, ECD (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.13‐4.45), use of machine perfusion (OR 0.45, 95% CI 0.22‐0.94), and optimal DMG at DND (OR 0.39, 95% CI 0.16‐0.99) were associated with DGF. Early achievement of DMGs was associated with a reduced risk of the development of DGF, independent of the use of machine perfusion. In a retrospective multicenter study, early achievement of donor management goals is associated with a reduced risk of developing delayed graft function in kidney transplant recipients, independent of the use of machine perfusion and donor quality.