Donor Hemodynamics as a Predictor of Outcomes After Kidney Transplantation From Donors After Cardiac Death

Allopurinol preconditioning attenuates renal ischemia/reperfusion injury by inhibiting HMGB1 expression in a rat model

“…A kidney allograft from a donor who died from brain or cardiac death may undergo a longer ischemic time because of unstable hemodynamic circulation 18 . Acute kidney injury prior to donation can also increase primary graft dysfunction and result in delayed graft function.…”

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“…This is of significant interest because it implied that there may be fairly minimal effects of cumulative ischemia imparted onto the DCD kidney, as the donor's blood pressure and oxygen saturation fall after withdrawal of support, but before death. 27,28 This group did find that early hemodynamic changes, particularly in oxygen saturation, within the first 10 minutes after withdrawal of life support were associated with recipient outcome after DCD renal transplantation. 27,29 However, time-to-death itself was not predictive of patient or graft survival.…”

“…27,28 This group did find that early hemodynamic changes, particularly in oxygen saturation, within the first 10 minutes after withdrawal of life support were associated with recipient outcome after DCD renal transplantation. 27,29 However, time-to-death itself was not predictive of patient or graft survival. 30 Similar findings have also been described by our European colleagues, who have recently observed that DCDs now comprise approximately 50% of all donors for deceased-donor renal transplants.…”

“…27,29 However, time-to-death itself was not predictive of patient or graft survival. 30 Similar findings have also been described by our European colleagues, who have recently observed that DCDs now comprise approximately 50% of all donors for deceased-donor renal transplants. 31 The story regarding donor hemodynamics in DCDs is still in evolution.…”

“…Data are beginning to suggest that warm ischemia time, at least regarding the kidney, is not quite as important as we once thought. 27 Investigators at the University of Pennsylvania recently showed, with a follow-up of 3 years, that time-to-death during DCD recoveries was not significantly associated with worse patient or graft outcomes. This is of significant interest because it implied that there may be fairly minimal effects of cumulative ischemia imparted onto the DCD kidney, as the donor's blood pressure and oxygen saturation fall after withdrawal of support, but before death.…”