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Kidney Week

Abstract: PO2561

Impact of Out-of-Hospital Organ Donor Cardiac Arrest and Cardiopulmonary Resuscitation on Donor Kidney Histology and Function

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Akram, Sami M., Harbor-UCLA Medical Center Department of Internal Medicine, Torrance, California, United States
  • Olano, Claudia Guadalupe, Harbor-UCLA Medical Center Department of Internal Medicine, Torrance, California, United States
  • Guevara, Nehemias Antonio, Harbor-UCLA Medical Center Department of Internal Medicine, Torrance, California, United States
  • Barba, Lilly M., Harbor-UCLA Medical Center Department of Internal Medicine, Torrance, California, United States

Group or Team Name

  • Kidney Transplantation Group
Background

The mortality rate of patients listed for kidney transplantation (KT) is 5 per 100-patient years. Due to an organ shortage crisis, expansion of KD pool (KDP)is critical (1). Kidney donors (KD) with out-of-hospital cardiac arrest (OHUS-CA) and cardiopulmonary resuscitation (CPR) have low acceptance rate due to presumed delayed graft function (DGF). Donor CA in controlled setting (in ICU) does not impact KF post engraftment (PE) (2) but impact of OHUS-CA is unknown. We propose that terminal serum creatinine (TSC) and Kidney histology (KH) immediatley prior to Kidney transplantation predict KF post KT. We did a nested cohort study to study the impact of OHUS-CA and CPR of KDs on KF and KH.
.

Methods

Our transplant program received thirty-five kidney organ donors offers with a procurement biopsy from UNOS during July to December 2019. Retrospectively we reviewed demographics, pre- hospitalization resuscitation information, hemodynamic data and KH. Four patients were excluded; two had missing data; one patient had ischemic infarct and one patient had kidney tumor. The study cohort (N=31) divided into CA-OHUS (N1 =16 and No Cardiac Arrest (No-CA, N2=15) groups. The change (delta) in serum creatinine (DSC) while under donor management (DM) compared in each group. Hypotension during donor management (H-DM) and acute tubular damage score (ATDS) from donor kidney biopsy compared within each group of the cohort.

Results

TSC and ATDS prior to KT were evaluated as surrogates for KF post engraftment and there was no difference between OHUS-CA and No-CA (standard) donors. Effect of ischemic preconditioning was noted in OHUS-CA group (Table). Longer the duration of CPR greater was the residual KF (Fig 1).

Conclusion

KF and KH in KD with OHUS-CA are similar to standard criteria donors hence should not be prejudiced. This will expand the KDP.

Results
Nested Cohort (N=31)Delta SC (DSC)H-DM (P val = 0.56)ATDS (0 = none; 1=mild)
OHUS-CA (n1=16)0.34 (SD 0.19), P val = 0.19/75/11
No-CA (n2=15)0.72 (SD 0.27, P val = 0.02)10/58/7