A metabolic approach during normothermic regional perfusion in uncontrolled donors after circulatory death-A pilot study.

The use of donation after circulatory death (DCD) has increased significantly to face the persistent mismatch between supply and demand of organs for transplantation. While controlled (c) DCDs have warm ischemic time (WIT) that can be estimated, the WIT is often inexact and extended in uncontrolled DCD (uDCD), making assessment of injury difficult. We aimed at investigating the effects of cold ischemia on potential donor organ damage in the course of nRP by assessing the dynamic variations of transaminases and creatinine values in 17 uDCD donors. In our series, lactate values did not show significant changes during the study period (P = 0.147). Creatinine values did not significantly changed while transaminases progressive increased throughout the study period, even if it was significant only for AST (P = 0.035). According to our data, nRP duration affects splanchnic organs, being the liver sensitive to hypoperfusion, and serial biochemical measurements could help in detecting organ functional status.

Factors influencing consent to organ donation after brain death certification: a survey of 29 Intensive Care Units.

BACKGROUND: Family refusal (FR) to heart beating donation (HBD) in Intensive Care Unit (ICU) is increasing in recent years with a significant impact on the number of transplantable organs. Fostering setting humanization, quality of relationships, respect for will and family reliance towards ICU could be relevant in containing FR to organ donation (OD) in ICU. Our aims were to highlight the effects of structural features of ICUs and humanization determinants on FR in HBD process, and to describe visiting policies, structure and modalities of support in ICUs. METHODS: A survey was conducted among all the ICUs of the Tuscany Region included in the National Transplant System of the Ministry of Health in Italy. Data on ICUs' general and architectural characteristics, visiting policies and support for families were collected. Baseline characteristics of brain dead certified patients (BDCPs) were retrieved from the Registry of the Regional Transplant Centre. RESULTS: Twenty-nine (93.5%) ICUs out of 31 completed the survey. 330 BDCPs were managed during 2016 in the ICUs studied, with an opposition rate of 33.3%. The following independent factors for opposition emerged: BDCPs' age (OR=1.025; 95% CI: 1.007-1.042; P=0.005), ICU length of stay (LOS) (OR=1.065; 95% CI: 1.005-1.128; P=0.034) and the availability of an ICU team trained in procurement (OR=0.472; 95% CI: 0.275-0.811; P=0.007). CONCLUSIONS: Older age of BDCPs and a prolonged ICU LOS resulted in FR. ICU team specific education emerged as the only modifiable protective factor for oppositions, thus continuous and in-depth training programs for physicians and nurses could be of importance in preventing FR.

Renal Resistive Index and mortality in critical patients with acute kidney injury.

BACKGROUND: The predictive role of Doppler Renal Resistive Index (RRI) for mortality was shown in chronic kidney disease. In selected populations of intensive care unit (ICU), RRI predicts acute kidney injury (AKI) occurrence and anticipates persistent AKI. No data are available about mortality. We investigated whether RRI assay at AKI diagnosis could predict AKI mortality in a 10-bed-mixed medical-surgical and trauma ICU of a tertiary referral teaching hospital. The association between RRI and persistent AKI at discharge was investigated. METHODS: One hundred and twenty-five of 1512 patients admitted from January 2010 to March 2013 who developed AKI during ICU stay were enrolled. Kidney function was evaluated daily according to risk, injury, failure, loss and end-stage criteria. At AKI diagnosis, we measured RRI. The association between RRI at AKI diagnosis and ICU death or persistent AKI at ICU discharge was analysed by multivariable logistic regression analysis. RESULTS: At AKI diagnosis, RRI was 0·77 (0·70-0·88) in survivors and 0·85 in nonsurvivors (0·79-0·94) (P = 0·002). RRI values were significantly associated with ICU death (OR = 1·63-95% CI 1·06-2·49, P = 0·025). A RRI cut-off value of 0·77 was identified by receiver operating characteristic curve. Multivariate analysis selected RRI and abdominal hypertension as strongest predictors of AKI mortality. At AKI diagnosis, RRI was 0·78 (0·70-0·85) or 0·85 (0·73-0·92) (P = 0·026) in patients with or without persistent AKI at discharge. Multivariate analysis selected RRI at AKI diagnosis as the strongest predictor of persistent AKI. CONCLUSIONS: High RRI values at AKI diagnosis are strictly and independently associated with in-ICU mortality and persistent AKI at ICU discharge.