Julie Murphy, Mercer University College of Pharmacy
According to the National Kidney Foundation, the number of kidney transplants that occurred in 2014 equaled 17,105 with 11,570 of those donations coming from deceased donors.1 A study of therapeutic hypothermia in cardiac arrest patients suggests that mild hypothermia is renal protective.2 According to this author, normothermia is the proper protocol to maintain neurologically deceased organ donors.3
|Title: Therapeutic Hypothermia in Deceased Organ Donors and Kidney-Graft Function3|
|Design||Randomized, prospective study; N= 302|
|Objective||To determine the effect of mild hypothermic organ donors on the rate of delayed graft function|
|Study Groups||Mild hypothermia (n= 150) and normothermia (n= 152)|
|Methods||The mild hypothermia donors were cooled to the temperature range of 34ºC to 35ºC and normothermia donors were warmed to the 36.5ºC to 37.5ºC range.|
|Duration||March 20, 2012, and October 17, 2013|
|Primary Outcome Measure||The presence or absence of delayed graft function requiring for dialysis during the first week post-transplant|
|Results||Hypothermia delayed graft function: 28.2%
Normothermia delayed graft function: 39.2%
P value 0.008
|Adverse Events||Common Adverse Events: N/A|
|Serious Adverse Events:
dysrhythmia and systemic hypertension in hypothermic donors
cardiac arrest in normothermia donors
|Percentage that Discontinued due to Adverse Events: N/A|
|Study Author Conclusions||Therapeutic hypothermia is statistically and clinically protective to kidney allographs|
This Data and Safety Monitoring board ended this study early due to evidence of a 38% lower incidence of delayed graft function in the hypothermic group. The study also suggests that hypothermic treatment was particularly beneficial to high-risk subgroups such as older patients with comorbidities. The initial analysis indicates that delayed graft function was associated with the creatinine level at enrollment, age, and cold-ischemia time but the benefit of hypothermia was still found to be significant. Although this trial was not completely blinded, the authors felt that there was no bias because the bedside care providers and study investigators were blinded. It was suggested that the primary outcome assessment was properly blinded because the assessment was made in a different facility than the donor facility.3
- Organ Donation and Transplantation Statistics. National Kidney Foundation. https://www.kidney.org/news/newsroom/factsheets/Organ-Donation-and-Transplantation-Stats. Accessed August 7, 2015.
- Wolfrum S, Pierau C, Radke PW, Schunkert H, Kurowski V. Mild therapeutic hypothermia in patients after out-of-hospital cardiac arrest due to acute ST-segment elevation myocardial infarction undergoing immediate percutaneous coronary intervention. Crit Care Med. 2008;36(6):1780-6.
- Niemann CU, Feiner J, Swain S, et al. Therapeutic Hypothermia in Deceased Organ Donors and Kidney-Graft Function. N Engl J Med. 2015;373(5):405-14.