Deceased donor management and demographic factors related to kidney allograft rejection and graft survival.

BACKGROUND

There is agreement that the number of organ donors and the number of organs recovered per donor are not maximized despite promotion of awareness and new guidelines for transplant teams. A single standard for donor management does not exist, in part because there is no consensus with respect to donor factors and management effect on transplant outcomes.

METHODS

This retrospective study analyzed the long-term outcomes of 402 deceased donor kidney transplant recipients with respect to donor factors. This study differed from previous studies in that all recipients were treated with the same selection and immunosuppressive protocols.

RESULTS

Factors associated with improved graft survival included cause of death, more organs donated, and lower peak sodium (P < .01). Delayed graft function (DGF) decreased if more organs were donated, but increased when the donor was given dopamine. Recipients of donor kidneys with higher final creatinine values were more likely to show DGF (P < .01). A decrease in acute rejection episodes was observed among patients whose donors had received dopamine, donated more organs, and had a shorter time between incision and cross clamp (P < .05). Kidneys from donors with a higher final creatinine displayed fewer rejection episodes; those with a higher peak creatinine experienced more rejection episodes (P < .05).

CONCLUSION

The effect of donor variables on kidney transplant outcomes is important and may not be consistent with traditional expectations. Additional data collection and assessment of both short- and long-term transplant outcomes are critical to improve our understanding of the impact of deceased donor factors and management.