The impact of meeting donor management goals on the development of delayed graft function in kidney transplant recipients.

Abstract

Many organ procurement organizations (OPOs) utilize preset critical care endpoints as donor management goals (DMGs) in order to standardize care and improve outcomes. The objective of this study was to determine the impact of meeting DMGs on delayed graft function (DGF) in renal transplant recipients. All eight OPOs of the United Network for Organ Sharing Region 5 prospectively implemented nine DMGs in every donor after neurologic determination of death (DNDD). "DMGs met" was defined a priori as achieving any seven of the nine DMGs and this was recorded at the time of consent for donation to reflect donor hospital ICU management, 12-18 h later, and prior to organ recovery. Multivariable analyses were performed to identify independent predictors of DGF (dialysis in the first week after transplantation) with a p<0.05. A total of 722 transplanted kidneys from 492 DNDDs were included. A total of 28% developed DGF. DMGs were met at consent in 14%, 12-18 h in 32% and prior to recovery in 38%. DGF was less common when DMGs were met at consent (17% vs. 30%, p=0.007). Independent predictors of DGF were age, Cr and cold ischemia time, while meeting DMGs at consent was significantly protective. The management of potential organ donors prior to consent affects outcomes and should remain a priority in the intensive care unit.

• Authors: D J Malinoski, M S Patel, O Ahmed, M C Daly, S Mooney, C O Graybill, C E Foster, A Salim, United Network for Organ Sharing (UNOS) Region 5 Donor Management Goals (DMG) Workgroup
• Journal: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons (Am J Transplant) Vol. 13 Issue 4 Pg. 993-1000 (Apr 2013) ISSN: 1600-6143 [Electronic] United States
• PMID: 23406284 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)
• Copyright: No claim to original US government worksJournal compilation © 2013 The American Society ofTransplantation and the American Society of Transplant Surgeons.

Topics

• Adult
• Brain Death
• Critical Care (methods)
• Delayed Graft Function
• Graft Survival
• Humans
• Intensive Care Units
• Kidney Transplantation (standards)
• Middle Aged
• Multivariate Analysis
• Prospective Studies
• Risk
• Tissue and Organ Procurement (standards)
• Treatment Outcome
• Young Adult