Trajectories of systolic blood pressure decline in kidney transplant donors prior to circulatory death and delayed graft function

Author:

Lin Yingxin12,Teixeira-Pinto Armando13,Craig Jonathan C4,Opdam Helen5,Chapman Jeremy C6,Pleass Henry67,Carter Angus8,Rogers Natasha M6,Davies Christopher E910,McDonald Stephen910,Yang Jean2,Lim Wai H1112,Wong Germaine136ORCID

Affiliation:

1. Sydney School of Public Health, University of Sydney , Sydney, NSW, Australia

2. Faculty of Science, School of Mathematics and Science, University of Sydney , Sydney, NSW, Australia

3. Centre for Kidney Research, Kids Research Institute, Children's Hospital at Westmead , Sydney, NSW, Australia

4. College of Medicine and Public Health, Flinders University , Adelaide, SA, Australia

5. Department of Surgery, DonateLife, Organ and Tissue Authority , Canberra, ACT, Australia

6. Centre for Transplant and Renal Research, Westmead Hospital , Sydney, NSW, Australia

7. Specialty of Surgery, University of Sydney , Sydney, NSW, Australia

8. Intensive Care Unit, Cairns Hospital , Cairns , QLD, Australia

9. Department of Renal Medicine, Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute , Adelaide, SA, Australia

10. Adelaide Medical School, University of Adelaide , Adelaide, SA, Australia

11. Faculty of Health and Medical Science, University of Western Australia , Perth , WA, Australia

12. Department of Renal Medicine, Sir Charles Gairdner Hospital , Perth , WA, Australia

Abstract

ABSTRACT Background Kidneys donated after circulatory death suffer a period of functional warm ischaemia before death, which may lead to early ischaemic injury. Effects of haemodynamic trajectories during the agonal phase on delayed graft function (DGF) is unknown. We aimed to predict the risk of DGF using patterns of trajectories of systolic blood pressure (SBP) declines in Maastricht category 3 kidney donors. Methods We conducted a cohort study of all kidney transplant recipients in Australia who received kidneys from donation after circulatory death donors, divided into a derivation cohort (transplants between 9 April 2014 and 2 January 2018 [462 donors]) and a validation cohort (transplants between 6 January 2018 and 24 December 2019 [324 donors]). Patterns of SBP decline using latent class models were evaluated against the odds of DGF using a two-stage linear mixed effects model. Results In the derivation cohort, 462 donors were included in the latent class analyses and 379 donors in the mixed effects model. Of the 696 eligible transplant recipients, 380 (54.6%) experienced DGF. Ten different trajectories, with distinct patterns of SBP decline were identified. Compared with recipients from donors with the slowest decline in SBP after withdrawal of cardiorespiratory support, the adjusted odds ratio (aOR) for DGF was 5.5 [95% confidence interval (CI) 1.38–28.0] for recipients from donors with a steeper decline and lowest SBP [mean 49.5 mmHg (standard deviation 12.5)] at the time of withdrawal. For every 1 mmHg/min reduction in the rate of decline of SBP, the respective aORs for DGF were 0.95 (95% CI 0.91–0.99) and 0.98 (95% CI 0.93–1.0) in the random forest and least absolute shrinkage and selection operator models. In the validation cohort, the respective aORs were 0.95 (95% CI 0.91–1.0) and 0.99 (95% CI 0.94–1.0). Conclusion Trajectories of SBP decline and their determinants are predictive of DGF. These results support a trajectory-based assessment of haemodynamic changes in donors after circulatory death during the agonal phase for donor suitability and post-transplant outcomes.

Funder

National Health and Medical Research Council

Publisher

Oxford University Press (OUP)

Subject

Transplantation,Nephrology

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