The impact of donor chemical overdose on the outcome of liver transplantation

Guidelines for the assessment and acceptance of potential brain-dead organ donors

Organ transplantation is the only alternative for many patients with terminal diseases. The increasing disproportion between the high demand for organ transplants and the low rate of transplants actually performed is worrisome. Some of the causes of this disproportion are errors in the identification of potential organ donors and in the determination of contraindications by the attending staff. Therefore, the aim of the present document is to provide guidelines for intensive care multi-professional staffs for the recognition, assessment and acceptance of potential organ donors.

Methamphetamine use in deceased kidney donors impairs one-yr graft function

BACKGROUND

Methamphetamine (MA) has cumulative deleterious effects on multiple organ systems. A history of MA exposure in kidney donors may affect adversely graft function in recipients.

METHODS

Between September 2000 and March 2004, all deceased kidney donors were identified from the local registry (97 donors). Twenty donors (21%) with any MA exposure through history or toxicology were selected. Donors that did not fulfill UNOS standard criteria were excluded. Donor characteristics and subsequent recipient characteristics were retrospectively compared with a control group without MA exposure histories. The main outcome measure was mean serum creatinine at one-yr post-transplant (Cr365). Secondary outcome measures of delayed graft function and rejection episodes were reviewed.

RESULTS

Baseline serum creatinine at seven d post-transplant were equivalent between groups (Cr7 = 2.5 +/- 2.0 vs. 2.8 +/- 3.4, p = 0.75). At one yr, Cr365 was significantly elevated in recipients of MA exposed kidneys compared with controls (1.9 +/- 1.0 vs. 1.4 +/- 0.4, p = 0.028). When adjusted for confounding variables, MA exposure lost its statistical significance (p = 0.07-0.09) as an independent predictor of increased Cr365.

CONCLUSION

Donor MA exposure may be associated with increased Cr365 in recipients. Transplant centers can expect to encounter donors with MA use histories at rates higher that regional use rates. Larger studies may demonstrate MA exposure as an independent predictor of impaired graft function.

The impact of donor cocaine use on the outcome of adult liver transplantation

BACKGROUND

To investigate the feasibility of adult liver transplantation from donors with cocaine use.

METHODS

Of 807 adult liver transplantations performed between 1994 and 2000, 72 donors (8.9%) were current cocaine users. Donor characteristics and post-transplantation outcomes were retrospectively compared between the 72 cocaine and 126 control group selected from the remaining 735 donors, matched for age and having no history of drug use.

RESULTS

Marijuana, opiates and amphetamines were drugs of abuse often present with cocaine. Except for a high incidence of acute alcohol use in the cocaine donors, donor characteristics were comparable. The cocaine group had a significantly higher graft loss within three months of transplant (18.1% vs. 7.9%, p < 0.05), and had a trend toward lower graft survival (76% vs. 86% at one yr).

CONCLUSIONS

Potential adverse effect of cocaine and substances concurrently involved on donor liver was suggested. To clarify the distinct acceptance criteria of cocaine users for liver donation, prospective study is warranted.