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Effect of Cardiac Arrest in Brain-dead Donors on Kidney Graft Function
Quentin Dubourg1, Emilie Savoye2, Sarah Drouin1,3
1Kidney Transplantation, APHP Sorbonne University, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France.
Insights
The time between cardiac arrest (CA) and kidney procurement impacts graft function. Delaying procurement after primary CA increases the risk of delayed graft function in kidney transplant recipients.
Area of Science:
- Nephrology
- Transplantation immunology
- Critical care medicine
Background:
- Cardiac arrest (CA) leads to renal ischemia in brain-dead kidney donors before organ procurement.
- Graft function post-transplantation is potentially influenced by the time interval between CA and organ procurement.
Purpose of the Study:
- To investigate the relationship between the time interval from cardiac arrest (CA) to organ procurement and kidney graft function.
- To identify risk factors for delayed graft function in kidney transplantations from donors with a history of CA.
Main Methods:
- Retrospective population-based study using a prospectively curated database of 1469 kidney transplantations in France (2015-2017).
- Donors had experienced either primary CA (cause of death) or secondary CA (intercurrent event).
- Delayed graft function was defined as the need for renal replacement therapy within the first week post-transplantation.
Main Results:
- Delayed graft function occurred in 31.7% of kidney transplantations.
- Factors associated with delayed graft function included donor function, vasopressor use, cardiovascular history, donor/recipient age, BMI, cold ischemia time, and time from primary CA to procurement.
- A time interval of less than 3 days from primary CA to procurement was associated with an increased risk of delayed graft function (OR 1.38).
Conclusions:
- The time to procurement after primary cardiac arrest is identified as a novel risk factor for delayed graft function.
- Further interventional studies are warranted to evaluate the impact of delaying procurement after CA on kidney graft outcomes.
Background:
Cardiac arrest (CA) causes renal ischemia in one-third of brain-dead kidney donors before procurement. We hypothesized that the graft function depends on the time interval between CA and organ procurement.
Methods:
We conducted a retrospective population-based study on a prospectively curated database. We included 1469 kidney transplantations from donors with a history of resuscitated CA in 2015-2017 in France. CA was the cause of death (primary CA) or an intercurrent event (secondary CA). The main outcome was the percentage of delayed graft function, defined by the use of renal replacement therapy within the first week posttransplantation.
Results:
Delayed graft function occurred in 31.7% of kidney transplantations and was associated with donor function, vasopressors, cardiovascular history, donor and recipient age, body mass index, cold ischemia time, and time to procurement after primary cardiac arrest. Short cold ischemia time, perfusion device use, and the absence of cardiovascular comorbidities were protected by multivariate analysis, whereas time <3 d from primary CA to procurement was associated with delayed graft function (odds ratio 1.38).
Conclusions:
This is the first description of time to procurement after a primary CA as a risk factor for delayed graft function. Delaying procurement after CA should be evaluated in interventional studies.
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