Insufficient hemodynamics during agonal phase-ie, 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 three-year graft survival. Primary non-function (PNF) rate was 6.6%, delayed graft function (DGF) rate was 67%, and graft survival at three 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 < 80 mmHg was associated with 2.19 times the odds (95% CI 1.08-4.46, P = .030) for DGF. In conclusion, duration of agonal phase is associated with early transplant outcome. SBP < 80 mmHg during agonal phase shows a better discrimination for transplant outcome than SpO2 < 60% does.

Clinical research/practice, Delayed graft function (DGF), Donors and donation: donation after circulatory death (DCD), Kidney failure/injury, Kidney transplantation/nephrology, Organ procurement and allocation, Primary nonfunction, Statistics,
American Journal of Transplantation
Erasmus MC: University Medical Center Rotterdam

Peters-Sengers, H. (H.), Houtzager, J.H.E. (J. H.E.), Heemskerk, M.B.A, Idu, M.M, Minnee, R.C, Klaasen, R.W. (R. W.), … Bemelman, F.J. (2018). DCD donor hemodynamics as predictor of outcome after kidney transplantation. American Journal of Transplantation. doi:10.1111/ajt.14676