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Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
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Organ donor management and delayed graft function in kidney transplant recipients: A multicenter retrospective cohort

Heloise Cardinal1, Florence Lamarche2, Stéphanie Grondin2

  • 1Department of Medicine, Centre Hospitalier Universitaire de Montréal, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|September 26, 2018
PubMed

Insights

Meeting donor management goals (DMGs) significantly reduces delayed graft function (DGF) risk after kidney transplants. This benefit is independent of machine perfusion, highlighting early DMG achievement as crucial for better transplant outcomes.

Area of Science:

  • Nephrology
  • Transplantation Surgery
  • Critical Care Medicine

Background:

  • Delayed graft function (DGF) is a significant complication following kidney transplantation.
  • Donor Management Goals (DMGs) are critical for optimizing organ quality.
  • The independent impact of meeting DMGs on DGF, separate from machine perfusion, requires clarification.

Purpose of the Study:

  • To investigate the association between meeting Donor Management Goals (DMGs) and the incidence of delayed graft function (DGF) after kidney transplantation.
  • To determine if meeting DMGs reduces DGF risk independently of machine perfusion use.

Main Methods:

  • Retrospective analysis of consecutive brain-dead donors and kidney transplant recipients (KTRs) from 5 adult transplant centers (June 2013 - December 2016).
  • Evaluation of Donor Management Goals (DMGs) met at donor neurologic death (DND) and organ procurement.
  • Definition of optimal DMG achievement as meeting ≥7 DMGs.
  • Multivariate analysis using generalized estimating equations to predict DGF, accounting for extended-criteria donors (ECDs) and machine perfusion.

Main Results:

  • The number of DMGs met increased from donor neurologic death (DND) to organ procurement (5.6 to 6.1, P < .001).
  • Delayed graft function (DGF) occurred in 23% of 214 KTRs; 55% received organs on machine perfusion.
  • Multivariate analysis identified extended-criteria donors (OR 2.24) as increasing DGF risk, while machine perfusion (OR 0.45) and optimal DMG at DND (OR 0.39) were associated with reduced DGF risk.

Conclusions:

  • Early achievement of Donor Management Goals (DMGs) is independently associated with a lower incidence of delayed graft function (DGF) in kidney transplantation.
  • Optimizing donor management is a critical strategy to improve kidney graft outcomes.
  • These findings support the implementation and adherence to comprehensive Donor Management Goals.

Keywords:
clinical research/practicecritical care/intensive care managementdelayed graft function (DGF)donation after brain death (DBD)donors and donationkidney transplantation/nephrologyorgan procurement and allocation

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