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Deniau B, Sen J, Chaussard M, Boutin L, Coutrot M, Guillemet L, Plaud B, Depret F, Dudoignon E. Early post-operative lactate increase following kidney transplant is associated with delayed graft function: A retrospective cohort study. Clin Transplant 2024; 38:e15288. [PMID: 38520246 DOI: 10.1111/ctr.15288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Delayed graft function (DGF) is a frequent complication following kidney transplant. This study aimed to assess the association between early post-operative lactate variation and DGF. METHODS This was a single center, retrospective cohort study between February 2021 and December 2022 in Saint-Louis Hospital (APHP, France). Venous lactate levels were measured immediately (H0) and 4 h (H4) after kidney transplant. The primary outcome was the occurrence of DGF (need for renal replacement therapy between transplantation and day 7). Secondary outcome was the occurrence of complications (i.e., death, vascular thrombosis, hemorrhagic shock, urological complications (hematoma, urinoma), local or systemic infection) between transplant and day 7. RESULTS Two hundred 12 patients were included, and 38 (17.9%) developed DGF. Venous lactate variation between H0 and H4 was higher in patients who developed DGF (-30 (IQR -83, -6)% vs. -15 (IQR -62, -11)%, p = .037), but the variation of level was more often positive (corresponding to an increased lactate production over time between H0 and H4) in patients who developed DGF ((28(85%) vs. 94(62%), p = .011). In multivariate logistic regression, positive venous lactate level variation between H0 and H4 was strongly associated with a reduced risk of developing DGF (OR .30 [.09-.79], p = .024). We did not find any association between post-operative hyperlactatemia and occurrence of complications between transplant and day 7. DISCUSSION DGF is a frequent complication following kidney transplantation. Its early prediction could help physicians optimize treatment and protect the kidney. Early venous lactate variation after kidney transplant could help to predict the occurrence of DGF.
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Affiliation(s)
- Benjamin Deniau
- Université de Paris Cité, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Saint-Louis-Lariboisière Hospital, AP-HP, Paris, France
- FHU PROMICE, Paris, France
- INI CRCT, Paris, France
| | - Juliane Sen
- Department of Anesthesiology, Critical Care and Burn Unit, University Saint-Louis-Lariboisière Hospital, AP-HP, Paris, France
| | - Maïté Chaussard
- Department of Anesthesiology, Critical Care and Burn Unit, University Saint-Louis-Lariboisière Hospital, AP-HP, Paris, France
| | - Louis Boutin
- Université de Paris Cité, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Saint-Louis-Lariboisière Hospital, AP-HP, Paris, France
- FHU PROMICE, Paris, France
| | - Maxime Coutrot
- Department of Anesthesiology, Critical Care and Burn Unit, University Saint-Louis-Lariboisière Hospital, AP-HP, Paris, France
| | - Lucie Guillemet
- Department of Anesthesiology, Critical Care and Burn Unit, University Saint-Louis-Lariboisière Hospital, AP-HP, Paris, France
| | - Benoit Plaud
- Université de Paris Cité, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Saint-Louis-Lariboisière Hospital, AP-HP, Paris, France
- FHU PROMICE, Paris, France
| | - François Depret
- Université de Paris Cité, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Saint-Louis-Lariboisière Hospital, AP-HP, Paris, France
- FHU PROMICE, Paris, France
- INI CRCT, Paris, France
| | - Emmanuel Dudoignon
- Université de Paris Cité, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Department of Anesthesiology, Critical Care and Burn Unit, University Saint-Louis-Lariboisière Hospital, AP-HP, Paris, France
- FHU PROMICE, Paris, France
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Eerola V, Sallinen V, Lempinen M, Helanterä I. Association of Procurement Time With Pancreas Transplant Outcomes in Brain-Dead Donors. Transpl Int 2023; 36:11332. [PMID: 37470064 PMCID: PMC10353260 DOI: 10.3389/ti.2023.11332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023]
Abstract
A brain-death-induced cytokine storm damages organs in an organ donor. However, a longer time period between declaration of brain death and organ procurement (procurement interval) is associated with improved outcomes in kidney, liver, heart, and lung transplantation. The aim of this study was to find the optimal procurement interval for pancreas transplantation. Association of procurement interval with pancreas graft outcomes was analyzed using multivariable models adjusted for variables possibly affecting procurement interval and outcomes. Altogether 10,119 pancreas transplantations were included from the Scientific Registry of Transplant Recipients. The median follow-up was 3.2 (IQR 1.01-6.50) years. During the first year, 832 (9.0%) grafts were lost, including 555 (6.0%) within the first 30 days. Longer procurement interval was associated with increased death-censored graft survival in a multivariable model (HR 0.944 95% CI 0.917-0.972, per 10-h increase, p < 0.001). A decreasing hazard of graft loss was observed also with 1-year, but not with 30-day graft survival. During 1-year follow-up, 953 (12.1%) patients had an acute rejection, and longer procurement interval was also associated with less acute rejections (OR 0.937 95% CI 0.900-0.976, per 10-h increase, p = 0.002) in the multivariable model. In conclusion, longer procurement interval is associated with improved long-term outcomes in pancreas transplantation.
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Eerola V, Helanterä I, Åberg F, Lempinen M, Mäkisalo H, Nordin A, Isoniemi H, Sallinen V. Timing of Organ Procurement From Brain-Dead Donors Associates With Short- and Long-Term Outcomes After Liver Transplantation. Transpl Int 2022; 35:10364. [PMID: 36118016 PMCID: PMC9472133 DOI: 10.3389/ti.2022.10364] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022]
Abstract
Brain death-induced cytokine storm is thought to harm transplantable organs. However, longer procurement times have been associated with non-inferior or better outcomes in kidney, heart, and lung transplants, while optimal procurement time for liver allografts is unknown. Our aim was to analyze the association of time interval from brain death to organ procurement with liver allograft outcomes in two nationwide cohorts. The association of procurement interval with graft survival and short-term complications was analysed in multivariable models. Altogether 643 and 58,017 orthotopic liver transplantations from brain-dead donors were included from Finland between June 2004 and December 2017 and the US between January 2008 and August 2018, respectively. Median time from brain death to organ procurement was 10.5 h in Finland and 34.6 h in the US. Longer interval associated with better graft survival (non-linearly, p = 0.016) and less acute rejections (OR 0.935 95% CI 0.894–0.978) in the US cohort, and better early allograft function (p = 0.005; Beta −0.048 95% CI −0.085 −(−0.011)) in the Finnish cohort, in multivariable models adjusted with Donor Risk Index, recipient age, Model for End-Stage Liver Disease and indication for transplantation. Progressive liver injury after brain death is unlikely. Rushing to recover seems unnecessary; rest and repair might prove beneficial.
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Eerola V, Helanterä I, But A, Lempinen M, Mäkisalo H, Nordin A, Isoniemi H, Sallinen V. The Association of Time to Organ Procurement on Short- and Long-Term Outcomes in Kidney Transplantation. Clin J Am Soc Nephrol 2021; 16:427-436. [PMID: 33637606 PMCID: PMC8011019 DOI: 10.2215/cjn.11420720] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/08/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Transplant centers in Europe aim to minimize the time from brain death to organ procurement (procurement delay), but evidence to justify this is scarce. In the United States, procurement times are significantly longer. Our objective was to analyze how procurement delay associates with kidney allograft outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Kidney transplantations from brain-dead donors were retrospectively analyzed from the Finnish Kidney Transplant Registry and the Scientific Registry of Transplant Recipients in the United States. Multivariable models were adjusted with donor and recipient characteristics, and the relationship between procurement delay and outcomes was modeled with cubic spline functions. RESULTS In total, 2388 and 101,474 kidney transplantations in Finland and the United States were included, respectively. The median procurement delay was 9.8 hours (interquartile range, 7.8-12.4) in Finland and 34.8 hours (interquartile range, 26.3-46.3) in the United States. A nonlinear association was observed between procurement delay and the risk of delayed graft function, with highest risk seen in short and very long procurement delays. In multivariable models, the lowest risk of delayed graft function was associated with procurement delay between 20 and 50 hours. In multivariable models, longer procurement delay was linearly associated with lower risk of graft loss (hazard ratio, 0.90/1 h longer; 95% confidence interval, 0.88 to 0.92; P<0.001). Acute rejection rates, for which data were only available from Finland, were not associated with procurement delay. CONCLUSIONS Longer procurement delay was associated with noninferior or even better kidney allograft outcomes.
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Affiliation(s)
- Verner Eerola
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ilkka Helanterä
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anna But
- Biostatistics Consulting, Department of Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marko Lempinen
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Heikki Mäkisalo
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Arno Nordin
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Helena Isoniemi
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ville Sallinen
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Van Raemdonck D, Vos R, Verleden GM, Neyrinck A. Invited Commentary. Ann Thorac Surg 2019; 108:1526-1527. [PMID: 31276646 DOI: 10.1016/j.athoracsur.2019.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 06/04/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium; University Hospitals Leuven and KU Leuven University, Leuven, Belgium.
| | - Robin Vos
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases, Metabolism and Ageing, KU Leuven University, Leuven, Belgium
| | - Geert M Verleden
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases, Metabolism and Ageing, KU Leuven University, Leuven, Belgium
| | - Arne Neyrinck
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven University, Leuven, Belgium
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