DCD Donor Hemodynamics as Predictor of Outcome After Kidney Transplantation

Insufficient hemodynamics during agonal phase-i.e. the period between withdrawal of life-sustaining treatment and circulatory arrest-in Maastricht category III circulatory-death donors (DCD) potentially exacerbate ischemia/reperfusion injury. We included 409 Dutch adult recipients of DCD donor kidneys transplanted between 2006 and 2014. Peripheral oxygen saturation (SpO2-with pulse oximetry at the fingertip) and systolic blood pressure (SBP-with arterial catheter) were measured during agonal phase, and were dichotomized into minutes of SpO2>60% or SpO2 80 mmHg or SBP <80 mmHg. Outcome measures were and primary non-function (PNF), delayed graft function (DGF), and 3-year graft survival. Primary non-function (PNF) rate was 6.6%, delayed graft function (DGF) rate was 67%, and graft survival at 3 years was 76%. Longer periods of agonal phase (median 16 min (IQR 11-23)) contributed significantly to an increased risk of DGF (p=.012), but not to PNF (P=.071) and graft failure (p=.528). Multiple logistic regression analysis showed that an increase from 7 to 20 minutes in period of SBP <80mmHg was associated with 2.19 times the odds (95%CI 1.08-4.46, p=0.030) for DGF. In conclusion, duration of agonal phase is associated with early transplant outcome. SBP <80mmHg during agonal phase shows a better discrimination for transplant outcome than SpO2