Impact of the use of vasoactive drugs in cardiac death donors on the early postoperative renal function and related complications in renal transplant recipients

Abstract

Background: To explore the impact of the use of vasoactive drugs in donation after cardiac death (DCD) donors on graft function, with an attempt to guide the clinical practices of organ preservation and DCD kidney transplantation. Methods:The clinical data of 187 DCD donors and 304 recipients who were operated on in our center from February 2018 to May 2019 were retrospectively analyzed. Based on whether vasoactive drugs were used for maintaining blood pressure in DCD donors, the renal donors and recipients were divided into a high-dose group (norepinephrine ≥1.3 μg/kg/min or in combination with dopamine), a low-dose group (norepinephrine <1.3 μg/kg/min or in conjunction with dopamine), and a no-medication group (without the use of vasoactive drugs). The clinical features, post-transplant renal function, and complications were compared among these three groups.Results: The early renal function 1 and 7 days after surgery was significantly superior in the high-dose group and no-medication group (P<0.05) but showed no significant difference between the low-dose group and the no-medication group (P>0.05). Blood urea nitrogen (BUN) on the 1st postoperative days was significantly higher in the high-dose group than in the low-dose group and the no-medication group (P<0.05).Renal function indicators, including serum creatinine (CRE), BUN, and blood uric acid (UA) on the 30th postoperative day, showed no significant difference among these three groups (P>0.05). The incidence of delayed graft function (DGF) after renal transplantation was significantly higher in the high-dose group than in the low-dose group and the no-medication group (P<0.05), whereas there was no significant difference between the groups in the incidences of graft rejection and infections (P>0.05). Conclusions:The use of vasoactive drugs in DCD donors can affect the early recovery of renal function in renal transplant recipients, particularly for those donors who are administered a high dose of vasoactive drugs. Therefore, donor maintenance should be performed cautiously with vasoactive drugs.

Dynamic changes of neutrophil-to-lymphocyte ratio in brain-dead donors and delayed graft function in kidney transplant recipients

“…According to AKI network criteria based on serum creatinine from admission to the terminal (irrespective of time between measurements and of urine output cutoffs), AKI was divided into three stages: stage 1, increase in serum creatinine ≥0.3 mg/dl (≥26.4 μmol/l) or 1.5–2 fold increase; stage 2, 2–3 fold increase in serum creatinine; and stage 3, >3 fold increase in serum creatinine, or serum creatinine ≥4.0 mg/dl (≥354 μmol/l) with an acute rise of at least 0.5 mg/dl (44 μmol/l) [ 21 ]. Recipients who had a serum creatinine level >400 μmol/l after post-transplant 7 days and/or needed hemodialysis during the first week after transplantation were diagnosed with DGF [ 22 , 23 ]. Acute rejection was assessed via Banff criteria by allograft biopsy [ 24 ].…”

Abdominal Organ Transplantation: Noteworthy Literature in 2020

“…However, only one outcome was reported using multivariate analysis: the lowdose group had a higher odds ratio compared with the no-medication group of having an improvement in serum creatinine on postoperative day 1 (OR = 2.998, 95% CI = 1.166-7.709, P = .023). 39 Swanson et al studied the impact of vasopressor use for donation after brain death (DBD) donors on delayed graft function. A total of 2985 DBD donors and 5554 kidney transplant recipients were identified.…”

“…However, only one outcome was reported using multivariate analysis: the low-dose group had a higher odds ratio compared with the no-medication group of having an improvement in serum creatinine on postoperative day 1 (OR = 2.998, 95% CI = 1.166-7.709, P = .023). 39…”

“…40 The results of Zhang et al and Swanson et al are not directly comparable since they studied DCD donors and DBD donors, respectively. 39,40 However, they both recognize that the management of vasoactive agents for deceased kidney donors may have important implications for graft outcomes. The optimal dose of vasoactive medications for different donor types requires additional research.…”