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Impact of spontaneous donor hypothermia on graft outcomes after kidney transplantation
Author(s) -
Schnuelle P.,
Mundt H. M.,
Drüschler F.,
Schmitt W. H.,
Yard B. A.,
Krämer B. K.,
Benck U.
Publication year - 2018
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14541
Subject(s) - medicine , hazard ratio , hypothermia , odds ratio , transplantation , kidney transplantation , dialysis , confidence interval , creatinine , urology , renal function , randomized controlled trial , retrospective cohort study , anesthesia , surgery
A previous donor intervention trial found that therapeutic hypothermia reduced delayed graft function ( DGF ) after kidney transplantation. This retrospective cohort study nested in the randomized dopamine trial (ClinicalTrials.gov identifier: NCT 000115115) investigates the effects of spontaneous donor hypothermia (core body temperature <36°C) on initial kidney graft function, and evaluates 5‐year graft survival. Hypothermia assessed by a singular measurement in the intensive care unit 4‐20 hours before procurement was associated with less DGF after kidney transplantation (odds ratio [ OR ] 0.56, 95% confidence interval [ CI ] 0.34‐0.91). The benefit was greater when need for more than a single posttransplant dialysis session was analyzed ( OR 0.48, 95% CI 0.28‐0.82). Donor dopamine ameliorated dialysis requirement independently from hypothermia in a temporal relationship with exposure ( OR 0.93, 95% CI 0.87‐0.98, per hour). A lower core body temperature in the donor was associated with lower serum creatinine levels before procurement, which may reflect lower systemic inflammation and attenuated renal injury from brain death. Despite a considerable effect on DGF , our study failed to demonstrate a graft survival advantage (hazard ratio [ HR ] 0.83, 95% CI 0.54‐1.27), whereas dopamine treatment was associated with improved long‐term outcome ( HR 0.95, 95% CI 0.91‐0.99 per hour).