From the Surgical Critical Care Section (M.B.S., M.C., S.D.L.C., J.Z., D.J.M.), Portland Veterans Affairs Medical Center; and Department of Surgery (M.B.S., S.D.L.C., J.Z., D.J.M.), Oregon Health and Science University, Portland, Oregon; University of California-Davis School of Medicine (T.E.), Sacramento, California; Department of Surgery (M.S.P.), Massachusetts General Hospital, Boston, Massachusetts; and Department of Surgery (S.R.), Temple University, Philadelphia, Pennsylvania.
J Trauma Acute Care Surg. 2014 Jan;76(1):62-8; discussion 68-9. doi: 10.1097/TA.0b013e3182ab0d9b.
The appropriate level of glucose control in organ donors after neurologic determination of death (DNDD) remains uncertain. We hypothesized that a glucose target of 180 mg/dL would be appropriate for optimizing organ transplantation rates and outcomes.
Demographic, critical care, organ transplantation, and graft outcome data were prospectively collected on all DNDDs in United Network for Organ Sharing (UNOS) Region 5 from 2010 to 2012. Glucose levels were assessed at four time points in the organ donation process. The primary outcome measure was having four or more organs transplanted per donor (OTPD). Univariate analyses were conducted to determine the relationship between glucose levels and OTPD, organ transplantation rates, and graft function. Multivariate analyses were performed to determine independent predictors of four or more OTPDs. Glucose levels were analyzed at the following cutoff points: 150 or less, 180, and 200 mg/dL. Results with a p < 0.05 are listed.
A total of 1,611 DNDDs had a mean (SD) age of 38 (17) years and 3.4 (1.7) OTPDs. Forty-one percent had four or more OTPDs. Glucose levels of 150 mg/dL or less were not associated with differences in organ use. Levels of 180 mg/dL or less were associated with more OTPDs (3.5 vs. 3.2), a higher rate of four or more OTPDs (42% vs. 34%), and more heart (34% vs. 28%), pancreas (18% vs. 11%), and kidney (85% vs. 81%) use. Levels of 200 mg/dL or less revealed similar results. However, only a level of 180 mg/dL or less was an independent predictor of four or more OTPDs (odds ratio, 1.4). All three levels were associated with higher kidney graft survival after a mean (SD) of 10 (6.0) months of follow-up (97% vs. 95%).
Hyperglycemia is common in DNDDs and is associated with lower organ transplantation rates and worse graft outcomes. Targeting a glucose level of 180 mg/dL or less seems to preserve outcomes and is consistent with general critical care guidelines.
Therapeutic study, level II.
在神经死亡判定后（DNDD）器官捐献者的血糖控制水平仍不确定。我们假设 180mg/dL 的血糖目标值将有利于优化器官移植率和结局。
从 2010 年到 2012 年，在 UNOS 区域 5 对所有接受 DNDD 的患者进行了人口统计学、重症监护、器官移植和移植物结局数据的前瞻性收集。在器官捐献过程的四个时间点评估血糖水平。主要结局指标是每位供者移植的器官数（OTPD）达 4 个或更多。进行单变量分析以确定血糖水平与 OTPD、器官移植率和移植物功能之间的关系。进行多变量分析以确定 OTPD 达 4 个或更多的独立预测因素。分析血糖水平在以下切点时的结果：150mg/dL 或更低、180mg/dL 和 200mg/dL。列出了 p 值小于 0.05 的结果。
共有 1611 例 DNDD，平均（SD）年龄为 38（17）岁，OTPD 数为 3.4（1.7）。41%的患者有 4 个或更多 OTPD。血糖水平为 150mg/dL 或更低与器官利用无差异相关。180mg/dL 或更低的血糖水平与更多的 OTPD（3.5 比 3.2）、更高的 4 个或更多 OTPD 率（42%比 34%）以及更多的心脏（34%比 28%）、胰腺（18%比 11%）和肾脏（85%比 81%）利用率相关。200mg/dL 或更低的水平也显示出类似的结果。然而，只有血糖水平 180mg/dL 或更低是 OTPD 达 4 个或更多的独立预测因素（比值比，1.4）。所有三个水平与平均（SD）10（6.0）个月的随访后更高的肾脏移植物存活率相关（97%比 95%）。
DNDD 中常见高血糖，与较低的器官移植率和较差的移植物结局相关。将血糖目标值设定在 180mg/dL 或更低似乎可以保留结局，并且与一般重症监护指南一致。
治疗性研究，II 级。
