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.

Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients

“…Implementation of some of the recommendations has been shown to improve outcomes; for example, implementation of the predefined donor management goals defined by the United Network for Organ Sharing (UNOS) has resulted in a significant decrease in the incidence of DGF in those cases where the donor management goals were met. 43 In addition, cardiovascular prediction models and risk calculators to predict the risk of developing cardiovascular complications posttransplant are being introduced in the clinic and their use may allow introduction of targeted interventions that will reduce morbidity and mortality. 44 However, comprehensive, standardized methods to identify, screen and manage potentially reversible risk factors for graft failure and patient death are lacking in many of the current guidelines, as discussed below.…”

“…43,365 The implementation of these strategies in clinical practice reduces the risk of DGF by approximately 50%. 43 Such donor management goals may, in the future, also include pretreating donors with low-dose dopamine pretransplantation to improve graft function (Table 15).…”

“…43,365 The implementation of these strategies in clinical practice reduces the risk of DGF by approximately 50%. 43 Such donor management goals may, in the future, also include pretreating donors with low-dose dopamine pretransplantation to improve graft function (Table 15). 366 With the progress made in organ preservation, the use of mild hypothermia may lower the rate of DGF in kidney transplant recipients, especially with the use of high-risk donors, such as donors with a high KDPI.…”

“…A variety of interventions can be considered for the prevention of EAD and nonanastomotic BS after liver transplantation Considerations for managing early ischemic injury and DGF in kidney transplantation 43,365,369,373 …”

Advancing Transplantation

“…40 Where these strategies have been implemented in clinical practice the risk of DGF in kidney transplantation has been reduced by approximately 50%. 40 Nowadays, we have to deal with a population of donors with organs that may be more susceptible to IRI; we are an aging society with older recipients and donors.…”