The Use of Stroke Volume Variation to Guide Donor Management Is Associated With Increased Organs Transplanted per Donor.

BACKGROUND: There is a national shortage of organs available for transplantation, and utilization rates for thoracic organs are less than 40%. In addition, the optimal method of assessing cardiovascular status during donor management is uncertain. FloTrac is a noninvasive hemodynamic technique that measures cardiac output and fluid responsiveness. Our objective was to measure the impact of using this technique to guide management on fluid balance, vasopressor usage, thyroid hormone usage, and pulmonary function. We hypothesized that FloTrac guidance will increase thoracic organs transplanted per donor (OTPD). METHODS: Data were prospectively collected on a convenience sample of 38 donors after neurologic determination of death. Organs transplanted, net fluid balance, dosage of vasopressors, dosage of thyroid hormone, and Pao2:Fio2 were compared between treatment and control groups. RESULTS: The treatment group had greater thoracic OTPD (1.3 [1.0] vs 0.4 [0.6], P = .004) and overall OTPD (4.3 [1.5] vs 2.7 [1.5], P = .002). Donors in the treatment group maintained a neutral fluid balance, had more thyroid hormone used, and had an improvement in oxygenation. CONCLUSION: The implementation of this technology to aid providers may help ameliorate the shortage of thoracic and overall organs available for transplantation.

Overseas organ donation during wartime operations: Benchmarking military performance against civilian practice.

BACKGROUND: Over the past 15 years of war, eligible U.S. military members donated organs overseas in Germany. Our hypothesis was that outcomes at a military treatment facility were comparable to a civilian cohort. METHODS: Military donors were matched 1:3 with a donor cohort from the U.S. United Network for Organ Sharing. Data were compared using univariate and multivariate analysis. Significance set at p < 0.05. RESULTS: Forty military organ donors were compared with 116 civilian matched donors. The military cohort conversion rate was 75.5% and recovered more organs per donor (4.6 vs. 4.0, p = 0.02) with more transplants (4.2 vs 3.5, p = 0.01). Multivariate analysis controlling for sex, age, and type of organ donation showed no difference in odds of total organs donated in the military versus civilian cohort (odds ratio 2.1, 95% CI 0.87-5.24, p = 0.10). CONCLUSIONS: Organ donation at a military treatment facility overseas can be accomplished successfully.

Bicarbonate and mannitol treatment for traumatic rhabdomyolysis revisited.

BACKGROUND: A rhabdomyolysis protocol (RP) with mannitol and bicarbonate to prevent acute renal dysfunction (ARD, creatinine >2.0 mg/dL) remains controversial. METHODS: Patients with creatine kinase (CK) greater than 2,000 U/L over a 10-year period were identified. Shock, Injury Severity Score, massive transfusion, intravenous contrast exposure, and RP use were evaluated. RP was initiated for a CK greater than 10,000 U/L (first half of the study) or greater than 20,000 U/L (second half). Multivariable analyses were used to identify predictors of ARD and the independent effect of the RP. RESULTS: Seventy-seven patients were identified, 24 (31%) developed ARD, and 4 (5%) required hemodialysis. After controlling for other risk factors, peak CK greater than 10,000 U/L (odds ratio 8.6, P = .016) and failure to implement RP (odds ratio 5.7, P = .030) were independent predictors of ARD. Among patients with CK greater than 10,000, ARD developed in 26% of patients with the RP versus 70% without it (P = .008). CONCLUSION: Reduced ARD was noted with RP. A prospective controlled study is still warranted.

The impact of blood transfusions in deceased organ donors on the outcomes of 1,884 renal grafts from United Network for Organ Sharing Region 5.

BACKGROUND: Historically, strategies to reduce acute rejection and improve graft survival in kidney transplant recipients included blood transfusions (BTs) before transplantation. While advents in recipient immunosuppression strategies have replaced this practice, the impact of BTs in the organ donor on recipient graft outcomes has not been evaluated. We hypothesize that BTs in organ donors after neurologic determination of death (DNDDs) translate into improved recipient renal graft outcomes, as measured by a decrease in delayed graft function (DGF). METHODS: Donor demographics, critical care end points, the use of BTs, and graft outcome data were prospectively collected on DNDDs from March 2012 to October 2013 in the United Network for Organ Sharing Region 5 Donor Management Database. Propensity analysis determined each DNDD's probability of receiving packed red blood cells based on demographic and critical care data as well as provider bias. The primary outcome measure was the rate of DGF (dialysis in the first week after transplantation) in different donor BT groups as follows: no BT, any BT, 1 to 5, 6 to 10, or greater than 10 packed red blood cell units. Regression models determined the relationship between donor BTs and recipient DGF after accounting for known predictors of DGF as well as the propensity to receive a BT. RESULTS: Data were complete for 1,884 renal grafts from 1,006 DNDDs; 52% received any BT, 32% received 1 to 5 U, 11% received 6 to 10, and 9% received greater than 10 U of blood. Grafts from transfused donors had a lower rate of DGF compared with those of the nontransfused donors (26% vs. 34%, p < 0.001). After adjusting for known confounders, grafts from donors with any BT had a lower odds of DGF (odds ratio, 0.76; p = 0.030), and this effect was greatest in those with greater than 10 U transfused. CONCLUSION: Any BT in a DNDD was associated with a 23% decrease in the odds of recipients developing DGF, and this effect was more pronounced as the number of BTs increased. LEVEL OF EVIDENCE: Therapeutic study, level III; epidemiologic/prognostic study, level II.