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      DCD donor hemodynamics as predictor of outcome after kidney transplantation.

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          Abstract

          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.

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          Author and article information

          Journal
          Am. J. Transplant.
          American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
          Wiley
          1600-6143
          1600-6135
          August 2018
          : 18
          : 8
          Affiliations
          [1 ] Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
          [2 ] Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center, University of Amsterdam, the Netherlands.
          [3 ] Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
          [4 ] Dutch Transplant Foundation, Leiden, the Netherlands.
          [5 ] Department of Surgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, the Netherlands.
          [6 ] Department of Nephrology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, the Netherlands.
          Article
          10.1111/ajt.14676
          29380523
          c011003a-e362-408b-be43-3476bf3f094c
          History

          kidney failure/injury,organ procurement and allocation,donors and donation: donation after circulatory death (DCD),statistics,clinical research/practice,delayed graft function (DGF),kidney transplantation/nephrology,primary nonfunction

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