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Impact of deceased organ donor demographics and critical care end points on liver transplantation and graft survival rates.

Abstract：

BACKGROUND:The criteria for organ acceptance remain inconsistent, which limits the ability to standardize critical care practices. We sought to examine predictors of liver graft use and survival to better guide the selection and management of potential organ donors. STUDY DESIGN:A prospective observational study of all donors managed by the 8 organ procurement organizations in United Network for Organ Sharing Region 5 was conducted from July 2008 to March 2011. Critical care end points that reflect the normal hemodynamic, acid-base, respiratory, endocrine, and renal status of the donor were collected at 3 time points. Critical care and demographic data associated with liver transplantation and graft survival rates were first determined using univariate analyses, and then logistic regression was used to identify independent predictors of these two outcomes. RESULTS:From 961 donors, 730 (76%) livers were transplanted and 694 (95%) were functioning after 74 ± 73 days of follow-up. After regression analysis, donor BMI (odds ratio [OR] = 0.94), male sex (OR = 1.89), glucose <150 mg/dL (OR = 1.97), lower dopamine dose (OR = 0.95), vasopressin use (OR = 1.95), and ejection fraction >50% (OR = 1.77) remained as independent predictors of liver use. Graft survival was associated with lower donor BMI (OR = 0.91) and sodium levels (OR = 0.95). CONCLUSIONS:After controlling for donor age, sex, and BMI, both hemodynamic and endocrine critical care end points were associated with increased liver graft use. Both donor BMI and lower sodium levels during the course of donor management were independently predictive of improved graft survival. These results may help guide the management and selection of potential organ donors after neurologic determination of death.

journal_name

J Am Coll Surg

journal_title

Journal of the American College of Surgeons

authors

Bloom MB,Raza S,Bhakta A,Ewing T,Patel M,Ley EJ,Margulies DR,Salim A,Malinoski D

doi

10.1016/j.jamcollsurg.2014.09.020

subject

Has Abstract

pub_date

2015-01-01 00:00:00

pages

38-47

issue

eissn

1072-7515

issn

1879-1190

pii

S1072-7515(14)01717-7

journal_volume

220

pub_type

杂志文章,多中心研究

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Impact of deceased organ donor demographics and critical care end points on liver transplantation and graft survival rates.