Impact of donor cardiopulmonary resuscitation on the outcome of simultaneous pancreas-kidney transplantation-a retrospective study.
cardiopulmonary resuscitation
donor selection
ischemia
patient and graft survival
reperfusion injury
simultaneous pancreas-kidney transplantation
Journal
Transplant international : official journal of the European Society for Organ Transplantation
ISSN: 1432-2277
Titre abrégé: Transpl Int
Pays: Switzerland
ID NLM: 8908516
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
31
07
2019
revised:
04
09
2019
accepted:
28
01
2020
pubmed:
6
2
2020
medline:
25
6
2021
entrez:
4
2
2020
Statut:
ppublish
Résumé
Previous cardiac arrest in brain-dead donors has been discussed as a potential risk factor in pancreas transplantation (PT), leading to a higher rate of organ refusal. This study aimed to assess the impact of cardiopulmonary resuscitation (CPR) in brain-dead donors on pancreas transplant outcome. A total of 518 type 1 diabetics underwent primary simultaneous pancreas-kidney (SPK) transplantation at our center between 1994 and 2018. Patients were divided into groups, depending on whether their donor had been resuscitated or not. A total of 91 (17.6%) post-CPR donors had been accepted for transplantation (mean duration of cardiac arrest, 19.4 ± 15.6 min). Those donors were younger (P < 0.001), had lower pancreas donor risk index (PDRI, P = 0.003), and had higher serum creatinine levels (P = 0.021). With a median follow-up of 167 months (IQR 82-229), both groups demonstrated comparable short- and long-term patient and graft survival. The resuscitation time (<20 min vs. ≥20 min) also showed no impact, with similar survival rates for both groups. A multivariable Cox regression analysis suggested no statistically significant association between donor CPR and patient or graft survival. Our results indicate that post-CPR brain-dead donors are suitable for PT without increasing the risk of complications.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
644-656Informations de copyright
© 2020 The Authors. Transplant International published by John Wiley & Sons Ltd on behalf of Steunstichting ESOT.
Références
Dholakia S, Royston E, Quiroga I, et al. The rise and potential fall of pancreas transplantation. Br Med Bull 2017; 124: 171.
Augustine T. Simultaneous pancreas and kidney transplantation in diabetes with renal failure: the gold standard? J Ren Care 2012; 38(Suppl 1): 115.
Gruessner AC, Gruessner RWG. Long-term outcome after pancreas transplantation: a registry analysis. Curr Opin Organ Transplant 2016; 21: 377.
Morath C, Zeier M, Döhler B, et al. Transplantation of the type 1 diabetic patient: the long-term benefit of a functioning pancreas allograft. Clin J Am Soc Nephrol 2010; 5: 549.
Wai PY, Sollinger HW. Long-term outcomes after simultaneous pancreas-kidney transplant. Curr Opin Organ Transplant 2011; 16: 128.
Eurotransplant International Foundation. Annual Report 2017. [Cited 2019 March 15]. Available from: https://www.eurotransplant.org/cms/mediaobject.php?file=Annual+Report+2017+HR10.pdf.
Stratta RJ, Fridell JA, Gruessner AC, Odorico JS, Gruessner RWG. Pancreas transplantation: a decade of decline. Curr Opin Organ Transplant 2016; 21: 386.
Kandaswamy R, Stock PG, Gustafson SK, et al. OPTN/SRTR 2017 annual data report: pancreas. Am J Transplant 2019; 19(Suppl 2): 124.
Proneth A, Schnitzbauer AA, Schenker P, et al. Extended pancreas donor program - the EXPAND study: a prospective multicenter trial testing the use of pancreas donors older than 50 years. Transplantation 2018; 102: 1330.
Sánchez-Hidalgo JM, Salamanca-Bustos JJ, Arjona-Sánchez Á, et al. What is the influence of both risk donor and risk receiver on simultaneous pancreas-kidney transplantation? Transplant Proc 2018; 50: 664.
Loss M, Drewitz KP, Apfelbacher CJ, et al. Why offered pancreases are refused in the allocation process-a descriptive study using routine data from eurotransplant. Transplantation 2013; 95: 1134.
Wiseman AC, Wainright JL, Sleeman E, et al. An analysis of the lack of donor pancreas utilization from younger adult organ donors. Transplantation 2010; 90: 475.
Vinkers MT, Rahmel AO, Slot MC, Smits JM, Schareck WD. How to recognize a suitable pancreas donor: a Eurotransplant study of preprocurement factors. Transplant Proc 2008; 40: 1275.
Pilarczyk K, Osswald BR, Pizanis N, et al. Use of donors who have suffered cardiopulmonary arrest and resuscitation in lung transplantation. Eur J Cardiothorac Surg 2011; 39: 342.
Matsumoto CS, Kaufman SS, Girlanda R, et al. Utilization of donors who have suffered cardiopulmonary arrest and resuscitation in intestinal transplantation. Transplantation 2008; 86: 941.
West S, Soar J, Callaway CW. The viability of transplanting organs from donors who underwent cardiopulmonary resuscitation: a systematic review. Resuscitation 2016; 108: 27.
Ventura-Aguiar P, Ferrer J, Paredes D, et al. Outcomes from brain death donors with previous cardiac arrest accepted for pancreas transplantation: a single-center retrospective analysis. Ann Surg 2019. https://doi.org/10.1097/SLA.0000000000003218
Schroering JR, Mangus RS, Powelson JA, Fridell JA. Impact of deceased donor cardiac arrest time on postpancreas transplant graft function and survival. Transplant Direct 2018; 4: e381.
Fridell JA, Rogers J, Stratta RJ. The pancreas allograft donor: current status, controversies, and challenges for the future. Clin Transplant 2010; 24: 433.
Mercatello A, Roy P, Ng-Sing K, et al. Organ transplants from out-of-hospital cardiac arrest patients. Transplant Proc 1988; 20: 749.
Delaunay L, Denis V, Darmon PL, Catoire P, Bonnet F. Initial cardiac arrest is a risk factor for failure of organ procurement in brain-dead patients. Transplant Proc 1996; 28: 2894.
Adrie C, Laurent I, Monchi M, Cariou A, Dhainaou J-F, Spaulding C. Postresuscitation disease after cardiac arrest: a sepsis-like syndrome? Curr Opin Crit Care 2004; 10: 208.
Land WG, Agostinis P, Gasser S, Garg AD, Linkermann A. Transplantation and damage-associated molecular patterns (DAMPs). Am J Transplant 2016; 16: 3338.
Ali AA, Lim E, Thanikachalam M, et al. Cardiac arrest in the organ donor does not negatively influence recipient survival after heart transplantation. Eur J Cardiothorac Surg 2007; 31: 929.
Orioles A, Morrison WE, Rossano JW, et al. An under-recognized benefit of cardiopulmonary resuscitation: organ transplantation. Crit Care Med 2013; 41: 2794.
Totsuka E, Fung JJ, Urakami A, et al. Influence of donor cardiopulmonary arrest in human liver transplantation: possible role of ischemic preconditioning. Hepatology 2000; 31: 577.
Hoyer DP, Paul A, Saner F, et al. Safely expanding the donor pool: brain dead donors with history of temporary cardiac arrest. Liver Int 2015; 35: 1756.
Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 1986; 74: 1124.
Ambros JT, Herrero-Fresneda I, Borau OG, Boira JMG. Ischemic preconditioning in solid organ transplantation: from experimental to clinics. Transpl Int 2007; 20: 219.
Stokfisz K, Ledakowicz-Polak A, Zagorski M, Zielinska M. Ischaemic preconditioning - current knowledge and potential future applications after 30 years of experience. Adv Med Sci 2017; 62: 307.
Robertson FP, Magill LJ, Wright GP, Fuller B, Davidson BR. A systematic review and meta-analysis of donor ischaemic preconditioning in liver transplantation. Transpl Int 2016; 29: 1147.
Nikeghbalian S, Mardani P, Mansoorian MR, et al. The effect of ischemic preconditioning of the pancreas on severity of ischemia/reperfusion-induced pancreatitis after a long period of ischemia in the rat. Transplant Proc 2009; 41: 2743.
Oehmann C, Benz S, Drognitz O, Pisarski P, Hopt UT, Obermaier R. Remote preconditioning reduces microcirculatory disorders in pancreatic ischemia/reperfusion injury. Pancreas 2007; 35: e45.
Rea TD, Cook AJ, Hallstrom A. CPR during ischemia and reperfusion: a model for survival benefits. Resuscitation 2008; 77: 6.
Krupičková P, Mlček M, Huptych M, et al. Microcirculatory blood flow during cardiac arrest and cardiopulmonary resuscitation does not correlate with global hemodynamics: an experimental study. J Transl Med 2016; 14: 163.
Ayami MS, Grzella S, Kykalos S, Viebahn R, Schenker P. Pancreas donor risk index but not pre-procurement pancreas allocation suitability score predicts pancreas graft survival: a cohort study from a large German pancreas transplantation center. Ann Transplant 2018; 23: 434.