Impact of spontaneous donor hypothermia on graft outcomes after kidney transplantation

4 years ago

Impact of spontaneous donor hypothermia on graft outcomes after kidney transplantation

B A Yard, U Benck, W H Schmitt, B K Krämer, P Schnuelle, F Drüschler, H M Mundt

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 five-year graft survival. Hypothermia assessed by a singular measurement in the ICU 4-20 hours before procurement was associated with less DGF after kidney transplantation (OR 0.56, 95%CI 0.34 – 0.91). The benefit was greater when need for more than a single post-transplant dialysis session was analyzed (OR 0.48, 95%CI 0.28 – 0.82). Donor dopamine ameliorated dialysis requirement independent 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 (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). This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/ajt.14541