Objective:

The Indiana Organ Procurement Organization (IOPO) has adopted deceased donor intensive care unit (ICU) management parameters to optimize placement of transplant organs. It is unknown if achieving these management parameters impacts on early graft function. This study analyzes the impact of donor management parameters (DMP) on early post liver transplant (LT) graft function.

Methods:

This is a retrospective analysis of donor records from 2008 to 2012, provided by IOPO. For each case, donor demographic information (age, weight, cause of death, length of intensive care unit stay) and DMP goals were recorded. Seven DMP criteria were recorded: serum sodium < 155 mEq, mean arterial pressure > 60 mmHg, use of < 2 vasopressors, serum pH 7.35-7.45, central venous pressure < 10 mmHg, PaO2/FiO2 > 300, and urine output 1-2 cc/kg/hr. These parameters were recorded as having been met or not met at four time points: admission, consent for donation, 12 hours post-consent, and time of procurement. Early liver graft function was assessed using alanine aminotransferase (ALT) and total bilirubin (TB) levels.

Results:

There were 262 liver transplants for which both donor and recipient data were available. The number of DMPs met was independent of donor gender, race, age, or cause of death. Of the 7 DMPs, the mean number met at each time period was: 3.4 (admission), 3.6 (consent for donation), 4.4 (12 hours after consent) and 4.3 (at procurement). The parameters most readily met at procurement were: < 2 vasopressors (97%), arterial pressure>60 (87%), pH 7.35 to 7.45 (67%) and sodium <155 (64%). DMPs poorly met were urine output (44%), oxygen>300 (40%), and CVP<10 (36%). Post-LT, peak serum ALT was lowest for the donors meeting 5-7 DMPs (ALT 321) and highest for those meeting < 4 DMPs (ALT 533; p<0.01). There was no difference among the groups with regard to TB. When comparing outcomes for each of the 7 criteria individually, those groups meeting each parameter had a lower peak ALT compared to those not meeting the DMP. For each parameter, there was little difference in post-LT TB levels.

Conclusions:

Previous research has demonstrated improved organ yield per donor when meeting established DMP. This study is the first to demonstrate less graft injury in the early post-LT period for those donors in whom DMPs are met.

Acknowledgement: The Indiana Organ Procurement Organization collected and provided the data utilized in this study.

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