DCD Donor Hemodynamics as Predictor of Outcome After Kidney Transplantation.

Insufficient hemodynamics during agonal phaseie, the period between withdrawal of life-sustaining treatment and circulatory arrestin 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<60%, and minutes of SBP > 80mmHg or SBP < 80mmHg. Outcome measures were primary non-function (PNF), delayed graft function (DGF), and three-year graft survival. Primary non-function (PNF) rate was 6.6%, delayed graft function (DGF) rate was 67%, and graft survival at threeyears was 76%. Longer periods of agonal phase (median 16min [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 20minutes in period of SBP < 80mmHg was associated with 2.19 times the odds (95% CI 1.08-4.46, P=.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<60% does. This investigation of the predictive ability of hemodynamics during the agonal phase of circulatory death donors shows that systolic blood pressure discriminates short-term transplant outcomes better than peripheral oxygenation does.