Anaesthetic management of brain-dead for organ donation: impact on delayed graft function after kidney transplantation

作者：Boutin C; Vachiery Lahaye F; Alonso S; Louart G; Bouju A; Lazarovici S; Perrigault P F; Capdevila X; Jaber S; Colson P; Jonquet O; Ripart J; Lefrant J Y^*; Muller L

来源：Annales Francaises d Anesthesie et de Reanimation, 2012, 31(5): 427-436.

DOI：10.1016/j.annfar.2011.11.027

• Brain death
• Organ retrieval
• Anaesthesia
• Delayed kidney graft function

Background. - The aim of this study was to report current anaesthetic management brain-dead organ donors and to assess its impact on delayed kidney graft DGF).
Methods. - To achieve this retrospective multicenter study, brain-dead patient records were analysed for the years 2005 to 2007. Expanded donor criteria, length of stay in ICU, duration of brain death, respect of recommended cold ischemia time, preoperative and intraoperative management, type of anaesthesia, hemodynamic and respiratory parameters during organ retrieval, and impact of anaesthesia on DGF were analysed.
Results. - One hundred and forty-nine out of 165 files were available. Sixty-two percent of donors received anaesthetic drugs. There were no differences in demographic characteristics between the anaesthesia group (group A) and the no-anaesthesia group (group NA). In group NA, the mean arterial pressure (MAP) > 65 mmHg was more frequent (53% vs. 29%, P < 0.01), but did not differ for maximal MAP. In group A, maximal heart rate was higher (120 vs. 105b/min, P = 0.02) and donors received significantly more colloids (P < 0.01). Independent risk factors of DGF included absence of hydroxyethyl starch infusion during the preoperative period and mechanical ventilation without PEEP.
Conclusion. - During organ retrieval, 62% of organ donors received anaesthetic drugs. Use of anaesthesia lead to lower MAP requiring more fluid challenge with colloids but did not influence the DGF.

• 出版日期2012-5