Donor cardiac arrest and cardiopulmonary resuscitation: impact on outcomes after simultaneous pancreas–kidney transplantation – a retrospective study

Abstract

Donor cardiac arrest and cardiopulmonary resuscitation (CACPR) has been considered critically because of concerns over hypoperfusion and mechanical trauma to the donor organs. We retrospectively analyzed 371 first simultaneous pancreas-kidney transplants performed at the Medical University of Innsbruck between 1997 and 2017. We evaluated short-and long-term outcomes from recipients of organs from donors with and without a history of CACPR. A total of 63 recipients received a pancreas and kidney graft from a CACPR donor. At 1, and 5-years, patient survival was similar with 98.3%, and 96.5% in the CACPR and 97.0%, and 90.2% in the non-CACPR group (log rank P = 0.652). Death-censored pancreas graft survival was superior in the CACPR group with 98.3%, and 91.4% compared to 86.3%, and 77.4% (log rank P = 0.028) in the non-CACPR group, which remained statistically significant even after adjustment [aHR 0.49 (95% CI 0.24-0.98), P = 0.044]. Similar relative risks for postoperative complications Clavien Dindo > 3a, pancreatitis, abscess, immunologic complications, delayed pancreas graft function, and relative length of stay were observed for both groups. Donors with a history of CACPR are, in the current practice, safe for transplantation. Stringent donor selection and short CPR durations may allow for outcomes surpassing those of donors without CACPR.

Solid Organ Donation From Brain-dead Donors With Cardiorespiratory Arrest After Snow Avalanche Burial: A Retrospective Single-center Study

“…8-10 Therefore, after thorough donor evaluation, a history of CPR alone is no longer considered a contraindication for organ donation in most institutions. 11-15…”

“…[8][9][10] Therefore, after thorough donor evaluation, a history of CPR alone is no longer considered a contraindication for organ donation in most institutions. [11][12][13][14][15] However, cardiac arrest in avalanche victims is predominately due to asphyxia, and data obtained from patients with primary cardiac arrest may not be extrapolated to this scenario involving suffocation and prolonged hypoxia. Organs from donors with a history of asphyxia, such as from hanging or drowning, have long been considered high risk for transplantation.…”

Effect of Cardiac Arrest in Brain-dead Donors on Kidney Graft Function

“…12,13 Nonetheless, on average, resuscitated CA does not impair allograft function in the recipient. 8,11,14-18 The favorable characteristics of these donors selected despite their history of CA might explain this result, as could the modification by other factors of the effects of ischemia in this situation. For example, experimental models show that a first ischemic episode can provide time-limited protection against a second injury, a phenomenon called ischemic preconditioning.…”

“…Donors’ renal function decreases after a resuscitated CA. 8,11 Other causes of warm ischemia during kidney transplantation, for example, vascular anastomosis time, also lead to poorer functional results. 12,13 Nonetheless, on average, resuscitated CA does not impair allograft function in the recipient.…”

2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 5. Post-cardiac arrest care

“…It has been reported that transplantation outcomes of donors who died due to brain death after ROSC are not bad compared to those of donors who have not undergone CPR. [200][201][202][203][204][205][206][207][208][209] Based on the results of published studies so far, it has been summarized that CPR does not affect outcomes of the transplanted organ. 210 Therefore, organ donation should be considered in comatose patients who ]fulfill neurological criteria for brain death after ROSC or cardiac arrest patients who have failed to ROSC from cardiac arrest.…”