Impact of spontaneous donor hypothermia on graft outcomes after kidney transplantation

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).