Cause Of Brain Death Research Articles

Effect of the Second Warm Ischemia Time and Its Components on Early and Long-term Kidney Graft Function

BackgroundDuring kidney transplantation, the total time of organ ischemia consists of first warm ischemia time (WIT1), cold ischemia time (CIT), and a second WIT (WIT2). Rising graft temperature during WIT2, which comprises the creation of vascular anastomoses, increases oxygen demand and tissue damage, especially in the kidney tubular cells. The aim of this study was to analyze the influence of WIT2 on early and long-term kidney graft function. MethodsWe performed a retrospective analysis of 554 consecutive adult recipients, who received their first kidney graft from a deceased donor between 2003 and 2013. ResultsMean WIT2 was 25.2 min. Donors' sex, age, presence of hypertension, body mass index (BMI), and the cause of brain death showed no effect on WIT2. Weak positive correlations were found between the duration of WIT2 and both recipients' age (r = 0.11; P < .01) and BMI (r = 0.14; P < .01). Multivariate regression analysis confirmed the independent influence of age (β = 0.107 [95% confidence interval, 0.017 to 0.197] per year; P = .02) but not BMI (P = .09). WIT2 influenced early graft function and was significantly longer in patients with primary graft nonfunction than in other recipients (35.3 vs 24.9 min; P < .01). According to receiver-operating characteristic curve analysis, a WIT2 value >26 min was predictive of primary graft nonfunction, with 64% specificity and 58% sensitivity. No correlations were found between WIT2 and estimated glomerular filtration rate in the long-term follow-up period. ConclusionsThis study found that WIT2 may significantly influence the early graft function. We also found that the creation time of vascular anastomoses does not affect the long-term kidney graft excretory function.

Pupil diameter for confirmation of brain death in adult organ donors in Japan.

AimThe criteria for brain death in Japan include a bilateral pupil diameter of ≥4 mm. We evaluated the appropriateness of a 4‐mm pupil diameter in adult brain‐dead donors in Japan.MethodsWe retrospectively reviewed the records of 148 consecutive adult brain‐dead donors with an average age of 46 years. All records were anonymously registered to the Japanese Ministry of Health, Labour and Welfare (the Japanese Ministry of Health and Welfare before 2001) from the various designated emergency institutes that performed organ donation under brain death from 1999 to 2012 in Japan.ResultsAll donors had a Glasgow Coma Scale score of 3, absence of all seven brain stem reflexes, an isoelectric electroencephalogram for >30 min, and apnea as tested by the standard method. All of these examinations were repeated approximately 6 h later for confirmation. The pupil diameter (average ± standard deviation) was 6.1 ± 1.1 mm at the first assessment and 6.4 ± 1.1 mm approximately 6 h later. The 95% probability distribution as calculated by statistical analysis was 3.93–8.30 mm in the left eye and 3.88–8.28 mm in the right eye in the first assessment, and 4.25–8.58 mm in the left eye and 4.32–8.43 mm in the right eye approximately 6 h later.ConclusionDespite the various original causes of brain death, we conclude that a pupil diameter of ≥4 mm is a reasonable criterion for brain death in adults.

An investigation into the factors effective in the consent of families with brain-dead patients candidates for organ donation in Isfahan, Iran in 2012-13.

Background:Studies have shown that, with regard to social, cultural, and institutional contexts, several factors affect family decision-making on organ donation. This study aimed to investigate the effective factors in organ donation by family members with brain-dead patients.Materials and Methods:This was a descriptive-comparative study in which a researcher-made questionnaire was used to collect data. The reliability of the questionnaire was obtained as 0.81 using Cronbach's alpha. The study sample consisted of 85 members of families with brain-dead patients in Isfahan, Iran in 2012–13. The collected data were analyzed using the Statistical Package for the Social Sciences version 20.0, and the level of significance was considered as <0.05.Results:The obtained results indicated that factors such as age, marital status, level of education, and cause of brain death did not have any effect on their families consent, whereas factors such as gender, duration of hospitalization, having an organ donation card, personal view of the brain-dead patient, and the number of patient's children had a significant relationship with the consent on organ donation. In addition, the care and treatment team were effective in family decisions regarding organ donation.Conclusions:In general, the necessary culture and increasing the population awareness and their knowledge can be a positive step in this regard and may bring about an easy and rapid acceptance of organ donation by the involved families.

Intensive care practices in brain death diagnosis and organ donation.

We conducted a multicentre study of 1844 patients from 42 Spanish intensive care units, and analysed the clinical characteristics of brain death, the use of ancillary testing, and the clinical decisions taken after the diagnosis of brain death. The main cause of brain death was intracerebral haemorrhage (769/1844, 42%), followed by traumatic brain injury (343/1844, 19%) and subarachnoid haemorrhage (257/1844, 14%). The diagnosis of brain death was made rapidly (50% in the first 24h). Of those patients who went on to die, the Glasgow Coma Scale on admission was ≤8/15 in 1146/1261 (91%) of patients with intracerebral haemorrhage, traumatic brain injury or anoxic encephalopathy; the Hunt and Hess Scale was 4-5 in 207/251 (83%) of patients following subarachnoid haemorrhage; and the National Institutes of Health Stroke Scale was ≥15 in 114/129 (89%) of patients with strokes. Brain death was diagnosed exclusively by clinical examination in 92/1844 (5%) of cases. Electroencephalography was the most frequently used ancillary test (1303/1752, 70.7%), followed by transcranial Doppler (652/1752, 37%). Organ donation took place in 70% of patients (1291/1844), with medical unsuitability (267/553, 48%) and family refusal (244/553, 13%) the main reasons for loss of potential donors. All life-sustaining measures were withdrawn in 413/553 of non-donors (75%).

Cardiac dysfunction following brain death in children: prevalence, normalization, and transplantation.

Cardiac dysfunction has been reported to occur in as much as 42% of adults with brain death, and may limit cardiac donation after brain death. Knowledge of the prevalence and natural course of cardiac dysfunction after brain death may help to improve screening and transplant practices but adequately sized studies in pediatric brain death are lacking. The aims of our study are to describe the prevalence and course of cardiac dysfunction after pediatric brain death. Cross-sectional study. We examined an organ procurement organization database (Life Center Northwest) of potential pediatric cardiac donors diagnosed with brain death between January 2011 and November 2013. Transthoracic echocardiograms were reviewed for cardiac dysfunction (defined as ejection fraction <50% or the presence of regional wall motion abnormalities). Descriptive statistics were used to analyze clinical characteristics and describe longitudinal echocardiogram findings in a subgroup of patients. We examined for heterogeneity between cardiac dysfunction with respect to cause of brain death. We identified 60 potential pediatric cardiac donors (age ≤ 18 yr) with at least one transthoracic echocardiogram following brain death. Cardiac dysfunction was present in 23 patients (38%) with brain death. Mean ejection fraction (37.6% vs 62.2%) and proportion of procured hearts (56.5% vs 83.8%) differed significantly between the groups with and without cardiac dysfunction, respectively. Of the 11 subjects with serial transthoracic echocardiogram data, the majority of patients with cardiac dysfunction (73%) improved over time, leading to organ procurement. No heterogeneity between cardiac dysfunction and particular causes of brain death was observed. The frequency of cardiac dysfunction in children with brain death is high. Serial transthoracic echocardiograms in patients with cardiac dysfunction showed improvement of cardiac function in most patients, suggesting that initial decisions to procure should not solely depend on the initial transthoracic echocardiogram examination results.

Variables Associated With the Risk of Early Death After Liver Transplantation at a Liver Transplant Unit in a University Hospital

BackgroundGraft dysfunction after liver transplantation is a serious complication that can lead to graft loss and patient death. This was a study to identify risk factors for early death (up to 30 days after transplantation). MethodsIt was an observational and retrospective analysis at the Liver Transplantation Unit, Hospital de Clinicas, State University of Campinas, Brazil. From July 1994 to December 2012, 302 patients were included (>18 years old, piggyback technique). Of these cases, 26% died within 30 days. For analysis, Student t tests and chi-square were used to analyze receptor-related (age, body mass index, serum sodium, graft dysfunction, Model for End-Stage Liver Disease score, renal function, and early graft dysfunction [EGD type 1, 2, or 3]), surgery (hot and cold ischemia, surgical time, and units of packed erythrocytes [pRBC]), and donor (age, hypotension, and brain death cause) factors. Risk factors were identified by means of logistic regression model adjusted by the Hosmer-Lemeshow test with significance set at P < .05. ResultsWe found that hyponatremic recipients had a 6.26-fold higher risk for early death. There was a 9% reduced chance of death when the recipient serum sodium increased 1 unit. The chance of EGD3 to have early death was 18-fold higher than for EGD1 and there was a 13% increased risk for death for each unit of pRBC transfused. ConclusionsDonor total bilirubin, hyponatremia, massive transfusion, and EGD3 in the allocation graft should be observed for better results in the postoperative period.

Transcranial Doppler in the Diagnosis of Cerebral Circulatory Arrest: Cases of the National Institute of Donation and Transplantation of Uruguay

BackgroundTranscranial Doppler (TCD) is an auxiliary method for the diagnosis of cerebral circulatory arrest (CCA). The objective of this work was to appreciate the efficiency of the method in the diagnosis of the CCA and its outcome in situations such as decompressive craniectomy (DC). MethodsIn this descriptive, retrospective study, conducted between 2000 and 2012, variables considered were causes of brain death (BD), age, sex, application reason, CCA patterns, and CCA patterns in DC. As a statistical approach, Pearson χ2 distribution was used. A total of 522 cases were analyzed; mean patient age was 30 ± 19 years, and 61% were men. ResultsThe principal causes of BD were traumatic brain injury, 44%; subarachnoid hemorrhage, 20%; and post–cardiac arrest anoxic ischemic injury, 17%. TCD was requested by contraindication to apnea testing in 84% of cases, and it diagnosed CCA in 79%. The most frequent pattern of CCA was the systolic spike (70%). CCA was diagnosed in patients with DC in 43% (23/54) compared with 79% (369/468) in those patients without this procedure (P = .0001), with the systolic spike being the most frequent pattern (48%). ConclusionsTCD is a useful and highly specific tool for the diagnosis of CCA that occurs with BD, diminishing its performance significantly in patients with DC.

Profile of Organ Donors in Ceará, Northeastern Brazil, From 1998 to 2012

The use of cadaver donors for transplantation is often the only alternative in the treatment of patients with organ failure. The purpose of this study was to draw a comprehensive profile of solid organ donors in Ceará, northeastern Brazil, from 1998 to 2012. The study was retrospective and based on secondary data regarding sex, age, blood typing, and cause of brain death obtained from the solid organ donor database of the Ceará Transplantation Center covering the period November 1998 to December 2012. During the study period, 976 donors (69% male) were used. Donors were distributed in 4 age groups as follows: 12.9% <18 years, 50.9% 18–40 years, 28.5% 41–60 years, and 7.7% >60 years. The average age was 35 ± 16 years. On the average, female donors were older than male donors (38.4 ± 17 y vs 33.5 ± 16 y; P < .0001). Men were predominant in the age groups 18–40 y (75.3%; P < .0001) and 41–60 y (59.4%; P < .0001). The main causes of brain death were traumatic brain injury (TBI) (56.7%) and stroke (33.1%). The former was more common in men (P < .0001), the latter in women (P < .0001). TBI was caused by traffic accidents (51.4%), of which 50.7% were motorcycle accidents, and urban violence (22.6%), of which 71.2% were associated with firearms. The number of donations increased in the study period (11.2 donors per million population in 1998–2002 to 68.1 in 2008–2012). In Ceará, solid organ donation is on the rise. The predominant donor profile was young men aged 18–40 years with brain death due to TBI caused by traffic accidents and urban violence.

Colombia: Social Transition and Peace Process. Has The Reduction in Violence Had Any Impact On Organ Procurement and Transplantation? New Society, New Strategies.

Introduction: Colombia is known worldwide for its high rates of violence as the result of the narcotics war and the presence of political-rebel groups; guerrillas. The violence increased dramatically during the 1990s and early 2000s, which is when it achieved its greatest influence. Nowadays the situation has changed. The Colombian government has retaken control, acting to decrease the macro and micro narco-traffic and a peace process with the guerrillas is ongoing. Because of this, Colombia is undergoing a social transition and the rate of all types of violence has decreased substantially. Aim: To investigate and report the direct impact of the decreased rates of violence on organ procurement and transplantation in Colombia. Materials and Methods: A 10-year retrospective study of national and international data reports on interpersonal violence, intentional homicide and car accidents including the data of The National Institute of Coroners and Forensic Science of Colombia. Results: The homicide rate in Colombia has decreased from 67.5 per 100,000 inhabitants in 2002 to 33 per 100,000 inhabitants in 2012; 91% of murders occurred in males aged 20 to 35 years in the last decade. The primary homicide trigger was the guerrillas war in 2002 and now seems to be the interpersonal fights in 2012. Although shooting has declined substantially from >24,000 in 2002 to <12,000 in 2012, it remains the most common mechanism of death (75%). On the other hand, the rate of deaths due to car accident has also decreased. Regarding organ procurement, the number of effective brain-death donors has decreased substantially. Also, the main cause of brain death changed from trauma in 2002 to stroke in 2012. Conclusions: It is quite interesting to see how the social transition and the peace process that Colombia is undergoing directly impacts on the health system including the Colombian Network of Organ Procurement and Transplantation (CNOPT). There is a reduction in all types of violence; brain-death donors due to gunshot wounds and traffic accidents are less now than 10 years ago. Thus, the transplants performed using living and extended-criteria donors are now fundamental. Designing new strategies has been necessary to adjust the CNOPT to a modern society, in order to increase the amount of effective donors. Those strategies may be an archetype to the countries that are living in a social transition like Colombia.

A Randomized Trial of the Effects of Nebulized Albuterol on Pulmonary Edema in Brain-Dead Organ Donors

Donor lung utilization rates are persistently low primarily due to donor lung dysfunction. We hypothesized that a treatment that enhances the resolution of pulmonary edema by stimulating the rate of alveolar fluid clearance would improve donor oxygenation and increase donor lung utilization. We conducted a randomized, blinded, placebo-controlled trial of aerosolized albuterol (5mg q4h) versus saline placebo during active donor management in 506 organ donors.The primary outcome was change in oxygenation arterial partial pressure of oxygen/fraction of inspired oxygen [PaO2/FiO2] from enrollment to organ procurement.The albuterol (n¼260) and placebo (n¼246)groups were well matched for age, gender, ethnicity,smoking, and cause of brain death. The change in PaO2/FiO2 from enrollment to organ procurement did not differ between treatment groups (p¼0.54) nor did donor lung utilization (albuterol 29% vs. placebo 32%,p¼0.44). Donors in the albuterol versus placebo groups were more likely to have the study drug dose reduced (13% vs. 1%, p<0.001) or stopped (8% vs. 0%,p<0.001) for tachycardia. In summary, treatment with high dose inhaled albuterol during the donor management period did not improve donor oxygenation or increase donor lung utilization but did cause tachycardia.High dose aerosolized albuterol should not be used in donors to enhance the resolution of pulmonary edema.

Considering ethical dilemmas related to brain death in newborns

Brain death (BD), as the irreversible and permanent loss of cerebral and brainstem function, is relatively uncommon among newborns who need life support. It is considered the result of an acute and irreversible central nervous system insult. Asphyxia, severe intracranial hemorrhage and infection are the most common causes of BD in children. BD diagnosis is usually based on clinical criteria. Dilemmas about life prolonging treatment for severely compromised infants – as brain dead infants are – has become challenging since neonatal intensive care unit ( NICU) care has developed, quality of life and resource issues are nowadays continuously underlined. Caring for premature babies is expensive and costs have risen especially since an increased number of infants with handicaps survives. Intensivists’ main duty is first to save lives and then to interrupt treatment in certain conditions like detrimental brain damage. The objective of this article is to present ethical decisions regarding brain dead newborns in order to balance between organ donation necessities and withholding/withdrawing treatment, with respect to the important role of infants’ parents in the process.

The usefulness of end-tidal carbon dioxide monitoring during apnea test in brain-dead patients.

BackgroundThe apnea test (AT) is essential to confirming the diagnosis of brain death, but critical complications can occur if the AT is maintained over a long period. To minimize the AT period, we used end-tidal carbon dioxide (ETCO2) monitoring because ETCO2 is closely correlated with partial pressure of arterial carbon dioxide (PaCO2). The aim of the present study is to evaluate the usefulness of ETCO2 monitoring during apnea testing.MethodsWe reviewed 61 patients who were pronounced brain dead at our hospital from July 2009 to December 2012. The subjects were divided into two groups: the N-group, in which capnography was not used, and the C-group, in which capnography was used to monitor ETCO2. In the C-group, whenever arterial blood was sampled, the PaCO2 - ETCO2 gradients were calculated and the ventilator setting adjusted to maintain normocapnia prior to apnea testing.ResultsTwenty-eight subjects in the N-group and twenty-nine subjects in the C-group were included. The gender ratio, age, and cause of brain death were not different between the two groups. Prior to the AT, the normocapnia ratio was higher in the C-group than in the N-group. During the AT, the total test period was shorter in the C-group. Moreover, systolic blood pressure increased in the C-group and decreased in the N-group during apnea testing.ConclusionsETCO2 monitoring during AT allows the PaCO2 level to be predicted, which reduces the duration of the test and stabilizes systolic blood pressure. Thus, with ETCO2 monitoring, the AT can be fast and safe.

Vasculopathy in the kidney allograft at time of transplantation delays recovery of graft function after deceased-donor kidney transplantation

The purpose of this study was to evaluate the impact of donor and recipient characteristics on duration of delayed graft function (DGF) and 1-year serum creatinine (SCr), as a surrogate endpoint for allograft survival. We reviewed 120 first cadaver kidney transplants carried out consecutively at our center to examine the effect on 1-year SCr of the presence and duration of DGF. DGF rate was 68%, with a median duration of 12 days (range, 1-61). Forty-four (38%) patients presented DGF lasting 12 or more days (prolonged DGF group). Mean donor age was 43 ± 13 years, 37% had hypertension and in 59% the cause of brain death was cardiovascular accident. The mean cold ischemia time was 23 ± 5 hours. Twenty-seven (23%) donors were classified as expanded-criteria donors according to OPTN criteria. The mean recipient age was 51 ± 15 years. The recipients median time in dialysis was 43 months (range, 1-269) and 25% of them had panel reactive antibodies > 0%. Patients with prolonged DGF presented higher 1-year SCr in comparison with patients without DGF (1.7 vs. 1.3 mg/dL, respectively, p = 0.03). In multivariate logistic regression analysis, the only significant factor contributing to the occurrence of prolonged DGF was the presence of vascular lesions in the kidney allograft at time of transplantation (HR 3.6, 95% CI 1.2-10.2; p = 0.02). The presence of vasculopathy in the kidney allograft at time of transplantation was identified as an important factor independently associated with prolonged DGF. Prolonged DGF negatively impacts 1-year graft function.

Profile of effective donors from organ and tissue procurement services

ObjectiveTo characterize the profile of effective organ and tissue donors and to understand which organs and tissues were donated for transplantation.MethodsThis was a quantitative, descriptive, exploratory, retrospective study that analyzed clinical data from 305 donors between January 2006 to December 2010. The data were then analyzed using descriptive analyses, generating frequency tables, measures of position (mean, minimum and maximum) and measures of dispersion (standard deviation) for data that was social and clinical in nature.ResultsThere was an overall predominance of white (72%) and male (55%) individuals between the ages of 41 and 60 years (44%). The primary cause of brain death was cerebrovascular accident (55%). In the patient history, 31% of the patients were classified as overweight, 27% as hypertensive and only 4.3% as having diabetes mellitus. Vasoactive drugs were used in 92.7% of the donors, and the main drug of choice was noradrenaline (81.6%). Hyperglycemia and hypernatremia were diagnosed in 78% and 71% of the donors, respectively.ConclusionSignificant hemodynamic changes were found, and the results indicate that the use of vasoactive drugs was the main strategy used to control these changes. Furthermore, most donors presented with hyperglycemia and hypernatremia, which were frequently reported in association with brain death. The persistent nature of these findings suggests that the organ donors were inadequately maintained.

Factors Predicting the Usefulness of Deceased Donors

BackgroundPreoperative management for deceased donation is important. Deceased donation can failed for several reasons. We analyzed the clinical data of deceased donation after consent for cadaveric donation to evaluate the reasons of failure of organ procurement. Material and MethodsWe retrospectively reviewed the medical records of 112 deceased donors in a single institution between January 1998 and September 2012. There were no organs from cardiac death donors. ResultsOf 112 deceased donors, 51 (45.5%) were traumatic brain deaths and 33 (29.5%), nontraumatic brain hemorrhages. The overall mean age was 37.2 (±16.6) years with 35 (30.7%) of female gender. There were 15 (13.3%) donation failures for all organs. Significant factors for failure were histories of cardiopulmonary resuscitation (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.05–0.58; P = .005), cardiac arrest (OR, 0.03; 95% CI, 0.006–0.14; P < .001), or acute renal failure (OR, 0.05; 95% CI, 0.006–0.42; P = .006). The nonsignificant factors included the time from intensive care unit to brain death (mean time, 105.1 ± 153.4); diabetes insipidus; hypotension despite inotrophic therapy, hypothermia (<35°C), arrhythmia, infection, metabolic acidosis, disseminated intravascular coagulopathy, and brain death cause. ConclusionsFailure of deceased donation was associated with cardiac arrest while awaiting organ procurement and the presence of an history of cardiopulmonary resuscitation or presence of acute renal failure.

Analysis of liver recipients survival with donor risk index (dri): a prospective study of cadaveric donors from OPO-HC-UNICAMP and their receptors

Introduction: In 2006, a donor risk index (DRI) was published based on data such as age, race, height, cause of brain death, cardio respiratory arrest, split-organ and ischemia time. Purpose: To study the survival rate of liver recipient with DRI. Method: This is an analytic and prospective study. The characteristics from the liver donor were: age (years), race (white/ black/Asian), height (cm), cause of brain death (anoxia, trauma, stroke or tumor), presence of cardiac arrest, cold ischemia time and procurement place (local, regional or national). The liver recipients’ characteristics were: age (years), etiology of liver disease, MELD score (total bilirubin, creatinine and IRN), warm ischemia time (minutes), ICU time (days), pre- transplant renal injury (yes/no) and Child-Pugh classification. From April 2008 to May 2009 all consecutive 66 OLTs and their respective DRI were analyzed. Recipients were followed up for at least six months in order to evaluate statistically the association between recipient survival and DRI at our service. The Kaplan-Meier method was used to analyze survival rate (using the log-rank test) and the Cox regression test to identify predictive factors. Results: There was statistical difference in the cumulative proportion of survival according to the 1.7 &gt;DRI&gt;1.7 levels (P=0.03). Recipients with MELD&gt; 24 had shorter survival rate (40%) than MELD ≤ 24 recipients (80%; P = 0.03) and the Cox regression test for survival time showed that patients with higher risk of death were: recipients with high values of MELD score and donor age with risk of death of 8% over 50 years; and DRI with 2% risk of death for each extra point. Conclusion: There was association between donor risk index and recipient survival. High MELD score values, DRI and donor age are variables that are found associated with the highest number of deaths and shorter survival.

Use of Lung Allografts from Brain-Dead Donors after Cardiopulmonary Arrest and Resuscitation

Patients who progress to brain death after resuscitation from cardiac arrest have been hypothesized to represent an underused source of potential organ donors; however, there is a paucity of data regarding the viability of lung allografts after a period of cardiac arrest in the donor. To analyze postoperative complications and survival after lung transplant from brain-dead donors resuscitated after cardiac arrest. The United Network for Organ Sharing database records donors with cardiac arrest occurring after brain death. Adult recipients of lung allografts from these arrest/resuscitation donors between 2005 and 2011 were compared with nonarrest donors. Propensity score matching was used to reduce the effect of confounding. Postoperative complications and overall survival were assessed using McNemar's test for correlated binary proportions and Kaplan-Meier methods. A total of 479 lung transplant recipients from arrest/resuscitation donors were 1:1 propensity matched from a cohort of 9,076 control subjects. Baseline characteristics in the 1:1-matched cohort were balanced. There was no significant difference in perioperative mortality, airway dehiscence, dialysis requirement, postoperative length of stay (P ≥ 0.38 for all), or overall survival (P = 0.52). A subanalysis of the donor arrest group demonstrated similar survival when stratified by resuscitation time quartile (P = 0.38). There is no evidence of inferior outcomes after lung transplant from brain-dead donors who have had a period of cardiac arrest provided that good lung function is preserved and the donor is otherwise deemed acceptable for transplantation. Potential expansion of the donor pool to include cardiac arrest as the cause of brain death requires further study.

Donor and recipient effects on graft and patient survival.

Deceased Donor Effects Donor Risk Index. The donor risk index attempts to quantify the recipient risk of graft failure associated with donor characteristics at the time of the organ offer: a donor age greater 40 years, donation after cardiac death, split grafts, African American race, shorter height, cerebrovascular accident, and other causes of brain death (Table 1). However, without clear evidence of improving outcomes, its clinical utility has been questioned.

Delayed Graft Function: Incidence and Risk Factors. Analysis of a Single Center

Introduction: Delayed Graft Function (DGF) is defined as need for dialysis during the first week after renal transplantation, and is associated with histological findings of acute tubular necrosis. Aim: To define the incidence of DGF in renal transplant recipients from deceased donors and identify risk factors. Methods: Retrospective analysis of medical records from renal transplant recipients from January to December 2010. Inclusion criteria: age > 18 years old at transplant, recipient from a kidney from deceased donor. Exclusion criteria: recipients from pancreas/kidney transplant, immediate graft loss due to vascular thrombosis. Results: One hundred and twenty one patients fulfill the inclusion criteria, and 103 had DGF (85%). The majority of patients were male (65%), aged 48 ± 11 years old, BMI 25 ± 4 kg/m2, with a length of dialysis of 45.1 ± 30.8 months pre transplant. The main cause of CKD was hypertension (25%). The donors were mostly male (53%), aged 40 ± 13 years, BMI 24.4 ± 2.8 kg/m2 with a serum creatinine at donation of 1.2 ± 0.8 mg/dl. The main causes of brain death was trauma (50%) and stroke (47%), and 27% of donors were classified as extended criteria donors. The number of matches was 1.3 ± 0.8 for locus AB and 1.3 ± 0.5 for DR, and 86% of patients had PRA < 10%. The mean cold ischemia time was 20.3 ± 5.3 hours. However, in 23% of cases cold ischemia exceeded 24 hours, with an incidence of 96.5% of DGF. The mineral metabolism profile included PTH levels of 515.4 ± 570 pg/ml; serum calcium 8.4 ± 0.7 mg/dL and serum phosphorus 5.2 ± 1.7 mg/dl. When groups with and without DGF were compared, we found an association of DGF with prolonged cold ischemia time (20.7 ± 5.3 vs 17.8 ± 4.8h, DGF x noDGF, p< 0.05), higher serum phosphorus (5.4 ± 1.7 vs. 4.2 ± 1.4 mg/dl, DGF x noDGF, p< 0.05) and higher calcium-phosphorus product (45.5 ± 16.1 vs. 34.9 ± 11.8, DGF x noDGF, p< 0.05). Conclusion: The incidence of DGF was elevated in this series, and was associated with prolonged cold ischemia time, and higher levels of phosphorus and calcium x phosphorus product at transplantation.

Assessment of Correlation Between Brain Imaging &amp; Organ Safety for Transplantation in Brain Death Patients

Introduction: Annually there are about 200 brain death donors in Iran. About 3 to 4 organs from each donor are available for transplantation. Because of organ failure, organ donation is not possible in many patients with brain death so organ maintenance will be necessary. It seems that type, place and severity of brain injury may influence on organ suitability. Our aim is to evaluate the correlation between brain imaging findings and organ suitability. Material and methods: In this retrospective study, we evaluated 162 files of brain death patients in organ procurement unit in ITB from 2002 to 2011. We extracted all information about demographic, clinical & laboratory findings and brain imagings. All data entered to SPSS 18 program for analysis. Results: There were 73 from 162 files with brain imaging. Mean age of these 162 brain death patients was 27± 12 years. The most common cause of brain death was Traumatic brain injury (55%), cerebral vascular accident (23%) and other causes (12%). Sites of brain injury was supratentorial(81.5%), infratentorial(6.5%) and cerebral generalized edema (12%). There was correlation between liver suitability and site of brain injury. Sites of Brain hemorrhage was intracerebral(32%), extracerebral(17%) and intra&extracerebral(51%) and there was significant correlation between heart suitability and brain hemorrhage. Conclusion: Presence of cerebral hemorrhage & site of pathological lesion in brain is correlated with heart and liver suitability and it seems that this effect may be due to hemodynamic states. This study emphasizes to stabilize optimal MAP in brain death patients to maintain organs' suitability for transplantation.