Impact of spontaneous donor hypothermia on graft outcomes after kidney transplantation

• Verfasst von: Schnülle, Peter [VerfasserIn]
• Verfasst von: Mundt, Heiko [VerfasserIn]
• Verfasst von: Drüschler, Felix [VerfasserIn]
• Verfasst von: Schmitt, Wilhelm [VerfasserIn]
• Verfasst von: Yard, Benito A. [VerfasserIn]
• Verfasst von: Krämer, Bernhard [VerfasserIn]
• Verfasst von: Benck, Urs Tobias [VerfasserIn]
• Titel: Impact of spontaneous donor hypothermia on graft outcomes after kidney transplantation
• Verf.angabe: P. Schnuelle, H.M. Mundt, F. Drüschler, W.H. Schmitt, B.A. Yard, B.K. Krämer, U. Benck
• Jahr: 2018
• Jahr des Originals: 2017
• Umfang: 11 S.
• Fussnoten: Gesehen am 04.07.2018
• Titel Quelle: Enthalten in: American journal of transplantation
• Ort Quelle: [Amsterdam] : Elsevier, 2001
• Jahr Quelle: 2018
• Band/Heft Quelle: 18(2018), 3, Seite 704-714
• ISSN Quelle: 1600-6143
• DOI: doi:10.1111/ajt.14541
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: clinical research/practice
• Sach-SW: delayed graft function (DGF)
• Sach-SW: donors and donation: donation after brain death (DBD)
• Sach-SW: graft survival
• Sach-SW: kidney (allograft) function/dysfunction
• Sach-SW: kidney transplantation/nephrology
• Sach-SW: organ procurement
• Sach-SW: organ procurement and allocation
• K10plus-PPN: 1577261461

Abstract

A previous donor intervention trial found that therapeutic hypothermia reduced delayed graft function (DGF) after kidney transplantation. This retrospective cohort study nested in the randomized dopamine trial (ClinicalTrials.gov identifier: NCT000115115) investigates the effects of spontaneous donor hypothermia (core body temperature <36°C) on initial kidney graft function, and evaluates 5-year graft survival. Hypothermia assessed by a singular measurement in the intensive care unit 4-20 hours before procurement was associated with less DGF after kidney transplantation (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.34-0.91). The benefit was greater when need for more than a single posttransplant dialysis session was analyzed (OR 0.48, 95%CI 0.28-0.82). Donor dopamine ameliorated dialysis requirement independently from hypothermia in a temporal relationship with exposure (OR 0.93, 95%CI 0.87-0.98, per hour). A lower core body temperature in the donor was associated with lower serum creatinine levels before procurement, which may reflect lower systemic inflammation and attenuated renal injury from brain death. Despite a considerable effect on DGF, our study failed to demonstrate a graft survival advantage (hazard ratio [HR] 0.83, 95%CI 0.54-1.27), whereas dopamine treatment was associated with improved long-term outcome (HR 0.95, 95%CI 0.91-0.99 per hour).