ABSTRACT
PURPOSE: The aim of this study was to analyze the importance of donor factors and especially the potential role of hemodynamic management in regard to delayed graft function in paired kidney recipient patients after renal transplantation and to analyze the urine of organ donors by proton-nuclear magnetic resonance spectroscopy to identify urine markers potentially correlated with delayed graft function in recipient patients. METHODS: A prospective multicenter epidemiologic study was conducted. A logistic regression model taking into account paired data was used. RESULTS: Data from 72 donors and the 144 corresponding paired recipients were analyzed. Univariate analysis showed that age of donor, previous history of tobacco, ischemic cause of brain death, norepinephrine infusion, and recipient age were the risk factors for delayed graft function. After adjusting for correlated outcome data and controlling for other potential prognostic factors, 3 variables remained significantly associated with outcome: donor age (odds ratio [OR], 10.7), hemodynamic status (OR, 0.167), and hydroxyl-ethyl starch infusion (OR, 0.135). Proton-nuclear magnetic resonance analysis evidenced 3 metabolites of interest in donors (trimethylamine-N-oxide, citrate, and lactate). However, these peaks were not correlated the clinical parameters in donors. CONCLUSIONS: Paired analysis of kidney transplantation emphasizes the important role of factor donor associated with delayed graft function in recipient. Thus, a particular attention should be paid to the hemodynamic management of donor.
Subject(s)
Delayed Graft Function/epidemiology , Hemodynamics , Kidney Transplantation/physiology , Tissue Donors/statistics & numerical data , Adolescent , Adult , Age Factors , Aged , Biomarkers/urine , Brain Death , Child , Citric Acid/urine , Delayed Graft Function/etiology , Female , Humans , Lactic Acid/urine , Logistic Models , Male , Methylamines/urine , Middle Aged , Prospective Studies , Risk Factors , Young AdultABSTRACT
The transplant of an allograft after cardiac arrest has been allowed in France since 2005 (decree of 2 august 2005: art R.1232-4-1, 2 and 3 of the public health code). Recently, according to the international scale, 4 situations that could lead to the realization of transplantable organs after cardiac arrest were identified according to a classification called "Maastricht" which describes the potential donors. In France the donors of class III (cessation of all medical care) were excluded. Ethical questions concerning this new practice come up. Are criteria adopted to define death enough sure? What is the place of non-heart beating donor transplantation with new technical resuscitation as extracorporeal life support for prolonged cardiac arrest? How does family and medical staff live this protocol? Despite this, non heart-beating donor kidney transplants offer the opportunity to compensate for the growing discrepancy between supply and demand for donor kidneys. Results from foreign studies have shown that they have the same survival and long term function as kidneys from traditional brain-stem dead donors. This practice is defined by legislation and supervised by the "Agence de la biomédecine" which guarantees technical efficiency and respect of ethics.
