The role of targeted temperature management before organ transplantation

This study aimed to investigate the clinical course of brain death donors and admitted through the emergency department before organ procurement and early outcomes of kidney transplantation. We retrospectively reviewed the medical records of patients who visited a single tertiary emergency department with the final diagnosis of brain death and donor procurement between January 2013 and January 2022. Donors were categorized into 3 groups: brain hemorrhage, hanging, and other medical causes. The primary outcome was the variation in the intensive care unit length of stay (LOS) across these groups. Secondary outcomes included organ procurement rates and factors influencing transplantation protocols, such as transplanted organs, age, sex, body mass index, cardiac arrest events, laboratory findings, and serial recipient laboratory results after organ transplantation. Medical records of 257 donors and 94 recipients for kidney transplantations were collected. The brain hemorrhage, hanging and other medical causes groups comprised 173 (67.3%), 53 (20.6%), and 31 (12.1%) patients, respectively. Of these, 102 patients (39.7%) experienced cardiac arrest before brain death. Targeted temperature management (TTM) was performed in 53 patients (20.6%). The mean time to organ procurement was 8.8 ± 6.4 days; the hemorrhage, hanging, and other medical causes groups averaged 6.9 ± 6.1, 7.1 ± 5.1, and 8.6 ± 5.1 days, respectively, with no significant differences (P = .29). However, TTM and non-TTM groups differed, averaging 10.9 ± 6.9 vs 8.2 ± 6.1 days (P = .013). The Kaplan-Meier curve indicated significant differences in LOS between these groups (P < .001). Before organ procurement, the TTM group's donors' sodium levels were better controlled at 143.4 ± 10.3 vs 150.1 ± 19.9 (P < .05). Consequently, the recipients' creatinine levels were lower than the non-TTM group on postoperative day 7 (1.68 ± 0.82 vs 2.67 ± 2.57; P < .01). The time to organ transplantation did not differ between the groups. However, the TTM group had a 2.7-day longer intensive care unit LOS before organ procurement than the non-TTM group. Before organ procurement, the TTM groups showed well-controlled sodium levels, and the kidney recipient group that received kidneys from the TTM group showed lower creatinine levels on postoperative day 7. It may represent more precise electrolyte imbalance management in post-cardiac arrest care using TTM.