The Impact of Duration of Brain Death on Outcomes in Abdominal Organ Transplantation: Rush and Retrieve or Rather Relax and Repair?
1Nuffield Department of Surgical Sciences, Oxford, United Kingdom
2NHS Blood and Transplant, Bristol, United Kingdom.
Meeting: 2015 American Transplant Congress
Abstract number: 13
Keywords: Brain death, Graft survival
Session Information
Session Name: Concurrent Session: Deceased Donor Management
Session Type: Concurrent Session
Date: Sunday, May 3, 2015
Session Time: 2:15pm-3:45pm
Presentation Time: 2:15pm-2:27pm
Location: Room 119-A
Background: Brain death (BD) induces a progressive systemic pro-inflammatory and coagulatory response affecting function of the grafts-to-be and survival. With longer BD duration more injury in donor organs becomes evident, but also up-regulation of defence mechanisms occurs initiating repair. This creates the dilemma whether to retrieve organs asap after consent to minimise the effects of hostile environment or optimise in-situ enhancing repair? Limited data are available with regards to this issue, and uncertainty increases, with the higher risk donors, when deciding which organ to accept or not for transplantation. We assessed the effect of BD duration on outcomes after kidney, liver and pancreas transplantation in the UK.
Methods: In a retrospective analysis, UK DBD donors during 2008-2012 were evaluated. Cox regression was used to investigate the relationship between BD duration and graft survival (GS) at 90d, 1 and 3y.
Results: Kidneys from 1881 donors used in adult-to-adult first kidney-only transplants were analysed. Median BD duration was 33h (IQR 25-48) in 2008 increasing to 36h (IQR 27-51) in 2012 (p=0.03). Longer BD did not have a detrimental effect on GS, in fact, prolonged BD duration led to increased GS following first kidney-only transplantation. Risk-adjusted Cox regression analyses of GS at 90d, 1 and 3y after kidney transplant suggest a significant interaction between BD duration and CIT (p=0.06, 0.02, 0.09 respectively). When CIT is 18-24h there is significant evidence that chance of graft failure decreases for every hourly increase in BD duration. There was a significant interaction between BD duration and year of donation (p=0.01, <0.005, 0.04, respectively) at 90d, 1 and 3y post pancreas transplant, but no association with GS for liver (p>0.6 in each case).
Discussion: Our study demonstrates that prolonged BD is not detrimental to outcomes in abdominal organ transplantation and actually beneficial to GS. This finding supports that time is required to adequately optimise organ donors and suggests a window of opportunity for in-situ organ conditioning with targeted intervention. This analysis renounces the need for a 'Rush and Retrieve' policy.
To cite this abstract in AMA style:
Boffa C, Curnow E, Martin K, Johnson R, Ploeg R. The Impact of Duration of Brain Death on Outcomes in Abdominal Organ Transplantation: Rush and Retrieve or Rather Relax and Repair? [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/the-impact-of-duration-of-brain-death-on-outcomes-in-abdominal-organ-transplantation-rush-and-retrieve-or-rather-relax-and-repair/. Accessed May 11, 2025.« Back to 2015 American Transplant Congress