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Major determinants of early renal graft function from kidney donation after Maastricht II circulatory death : a single center experience
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Resumo(s)
O transplante renal é a melhor terapêutica a oferecer a doentes com doença renal crónica no estadio terminal. A escassez de dadores de órgãos impede a prestação dos melhores cuidados a esta população. Consequentemente, foi aprovada em Portugal a doação de dadores em morte por paragem cardiocirculatória não controlada (DPCCnC). O principal objetivo deste trabalho é identificar os componentes do programa de doação implementado no Centro Hospitalar Lisboa Norte (CHLN) que têm maior impacto na função precoce do enxerto. Neste estudo observacional e retrospetivo, foi observada a função dos enxertos renais transplantados no CHLN pelo protocolo DPCCnC, com seguimento mínimo de seis meses. Através dos ficheiros eletrónicos dos doentes foram colhidos dados referentes aos dadores, os tempos das várias fases do protocolo e dados referentes aos recetores, nomeadamente função renal, falência de enxerto e mortalidade. Foram transplantados 31 rins de 21 dadores. Nos dadores, a média de tempos de isquemia quente, canulação e perfusão abdominal em regime de normotermia (ANOR) foi de 105 minutos, 18 minutos e 165 minutos, respetivamente. Dos recetores, 29% tiveram função imediata, 61,3% tiveram função tardia (FTE) e 9,7% disfunção primária do enxerto (DPE). O tempo de canulação e a duração de ANOR, tiveram impacto na função renal precoce dos recetores (p=0,001 e 0,021, respetivamente). Os enxertos que apresentaram DPE tiveram maior tempo de canulação que os com FTE e função imediata (p=0,005). Aqueles com FTE apresentaram uma duração de ANOR menor que os com função imediata (p=0,015). O valor de lactato à admissão de 19,9mmol/L ou superior foi preditor de DPE com elevada sensibilidade e especificidade. Assim, é de destacar o possível valor preditivo do lactato, bem como o impacto do tempo de ANOR e de canulação na função precoce do enxerto. A individualização destes parâmetros em estudos futuros é fundamental para otimização dos protocolos.
Kidney transplantation is superior to dialytic therapies when treating patients with end stage kidney disease. The shortage of organ donors impairs provision of the best health care to this population and strategies such as donation from donors after uncontrolled circulatory death (uDCD) have been legislated in Portugal. The primary goal of this study is to identify the impactful components in the uDCD program implemented in North Lisbon Hospital Centre (NLHC) regarding early graft function. In this observational and retrospective study carried out in NLHC, kidney graft function was evaluated in uDCD recipients, with a minimum follow-up of six months. The data was collected from the patients’ files. Donor characteristics and analytic parameters, protocol timings and recipient data, namely kidney function, graft failure and mortality, were included. Thirty-one kidneys were transplanted from twenty-one donors. Regarding donors, mean warm ischemia time, canulation time and abdominal normothermic organ reperfusion (ANOR) time were 105 minutes, 18 minutes and 165 minutes, respectively. Concerning recipients, 29% had immediate graft function, 61,3% had delayed graft function (DGF) and 9,7% had primary nonfunction (PNF). Early graft function outcomes were influenced by canulation time and ANOR duration (p=0,001 e 0,021, respectively). Kidneys with PNF experienced longer canulation times than kidneys with delayed or immediate function (p=0,005). ANOR duration was lower for kidneys with DGF than for kidneys with immediate function (p=0,015). Admission lactate levels of at least 19,9mmol/L predicted PNF with high sensibility and sensitivity. In this manner, this study emphasizes the possible predictive value of lactate and the impact ANOR duration and canulation time can have on early graft function. Studies with individualized parameters are crucial to optimize protocols.
Kidney transplantation is superior to dialytic therapies when treating patients with end stage kidney disease. The shortage of organ donors impairs provision of the best health care to this population and strategies such as donation from donors after uncontrolled circulatory death (uDCD) have been legislated in Portugal. The primary goal of this study is to identify the impactful components in the uDCD program implemented in North Lisbon Hospital Centre (NLHC) regarding early graft function. In this observational and retrospective study carried out in NLHC, kidney graft function was evaluated in uDCD recipients, with a minimum follow-up of six months. The data was collected from the patients’ files. Donor characteristics and analytic parameters, protocol timings and recipient data, namely kidney function, graft failure and mortality, were included. Thirty-one kidneys were transplanted from twenty-one donors. Regarding donors, mean warm ischemia time, canulation time and abdominal normothermic organ reperfusion (ANOR) time were 105 minutes, 18 minutes and 165 minutes, respectively. Concerning recipients, 29% had immediate graft function, 61,3% had delayed graft function (DGF) and 9,7% had primary nonfunction (PNF). Early graft function outcomes were influenced by canulation time and ANOR duration (p=0,001 e 0,021, respectively). Kidneys with PNF experienced longer canulation times than kidneys with delayed or immediate function (p=0,005). ANOR duration was lower for kidneys with DGF than for kidneys with immediate function (p=0,015). Admission lactate levels of at least 19,9mmol/L predicted PNF with high sensibility and sensitivity. In this manner, this study emphasizes the possible predictive value of lactate and the impact ANOR duration and canulation time can have on early graft function. Studies with individualized parameters are crucial to optimize protocols.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Doação de dadores em morte por paragem cardiocirculatória não controlada Função precoce do enxerto Tempo de perfusão abdominal em regime de normotermia Tempo de canulação Lactato Medicina intensiva