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Madhukar S Patel - One of the best experts on this subject based on the ideXlab platform.

  • impact of deceased Donor Management on Donor heart use and recipient graft survival
    2020
    Co-Authors: Elizabeth A Swanson, Madhukar S Patel, Claus U Niemann, Mitchell B Sally, Kiran K Khush, Tony Adams, Salvador De La Cruz, Michael Hutchens, Tahnee Groat, Darren Malinoski
    Abstract:

    Background Current risk-adjusted models used to predict Donor heart use and cardiac graft survival from organ Donors after brain death (DBDs) do not include bedside critical care data. We sought to identify novel independent predictors of heart use and graft survival to better understand the relationship between Donor Management and transplantation outcomes. Study Design We conducted a prospective observational study of DBDs managed from 2008 to 2013 by 10 organ procurement organizations. Demographic data, critical care parameters, and treatments were recorded at 3 standardized time points during Donor Management. The primary outcomes measures were Donor heart use and cardiac graft survival. Results From 3,433 DBDs, 1,134 hearts (33%) were transplanted and 969 cardiac grafts (85%) survived after 684 ± 392 days of follow-up. After multivariable analysis, independent positive predictors of heart use included standard criteria Donor status (odds ratio [OR] 3.93), male sex (OR 1.68), ejection fraction > 50% (OR 1.64), and partial pressure of oxygen to fraction of inspired oxygen ratio > 300 (OR 1.31). Independent negative predictors of heart use included Donor age (OR 0.94), BMI > 30 kg/m2 (OR 0.78), serum creatinine (OR 0.83), and use of thyroid hormone (OR 0.78). As for graft survival, after controlling for known recipient risk factors, thyroid hormone dose was the only independent predictor (OR 1.04 per μg/h). Conclusions Modifiable critical care parameters and treatments predict Donor heart use and cardiac graft survival. The discordant relationship between thyroid hormone and Donor heart use (negative predictor) vs cardiac graft survival (positive predictor) warrants additional investigation.

  • vasopressor selection during critical care Management of brain dead organ Donors and the effects on kidney graft function
    2020
    Co-Authors: Elizabeth A Swanson, Madhukar S Patel, Claus U Niemann, Darren Malinoski, Tahnee Groat, Nora E Jameson, Margaret Katherine Ellis, Michael P Hutchens, Mitchell B Sally
    Abstract:

    Background Delayed graft function (DGF), the need for dialysis in the first week following kidney transplant, affects approximately one quarter of deceased-Donor kidney transplant recipients. Donor demographics, Donor serum creatinine, and graft cold ischemia time are associated with DGF. However, there is no consensus on the optimal Management of hemodynamic instability in organ Donors after brain death (DBDs). Our objective was to determine the relationship between vasopressor selection during Donor Management and the development of DGF. Methods Prospective observational data, including demographic and critical care parameters, were collected for all DBDs managed by 17 organ procurement organizations from nine Organ Procurement and Transplantation Network Regions between 2012 and 2018. Recipient outcome data were linked with Donor data through Donor identification numbers. Donor critical care parameters, including type of vasopressor and doses, were recorded at three standardized time points during Donor Management. The analysis included only Donors who received at least one vasopressor at all three time points. Vasopressor doses were converted to norepinephrine equivalent doses and analyzed as continuous variables. Univariate analyses were conducted to determine the association between Donor variables and DGF. Results were adjusted for known predictors of DGF using binary logistic regression. Results Complete data were available for 5,554 kidney transplant recipients and 2,985 DBDs. On univariate analysis, Donor serum creatinine, Donor age, Donor subtype, kidney Donor profile index, graft cold ischemia time, phenylephrine dose, and dopamine dose were associated with DGF. After multivariable analysis, increased Donor serum creatinine, Donor age, kidney Donor profile index, graft cold ischemia time, and phenylephrine dose remained independent predictors of DGF. Conclusion Higher doses of phenylephrine were an independent predictor of DGF. With the exception of phenylephrine, the selection and dose of vasopressor during Donor Management did not predict the development of DGF. Level of evidence Prognostic study, Level III.

  • the role of deceased Donor liver biopsy an analysis of 5449 liver transplant recipients
    2020
    Co-Authors: Madhukar S Patel, Claus U Niemann, Mitchell B Sally, Darren Malinoski, Tahnee Groat, Jahan Mohebali, Taylor M Coe, Parsia A Vagefi
    Abstract:

    BACKGROUND No standard exists for the use of deceased Donor liver biopsy during procurement. We sought to evaluate liver biopsy and the impact of findings on outcomes and graft utilization. METHODS A prospective observational study of Donors after neurologic determination of death was conducted from 02/2012-08/2017 (16 OPOs). Donor data were collected through the UNOS Donor Management Goals Registry Web Portal and linked to the Scientific Registry of Transplant Recipients (SRTR) for recipient outcomes. Recipients of biopsied Donor livers (BxDL) were studied and a Cox proportional hazard analysis was used to identify independent predictors of 1-year graft survival. RESULTS Data from 5449 liver transplant recipients were analyzed, of which 1791(33%) received a BxDL. There was no difference in graft or patient survival between the non-BxDL and BxDL recipient groups. On adjusted analysis of BxDL recipients, macrosteatosis (21%-30%[n = 148] and >30%[n = 92]) was not found to predict 1-year graft survival, whereas increasing Donor age (HR1.02), Donor Hispanic ethnicity (HR1.62), Donor INR (HR1.18), and recipient life support (HR2.29) were. CONCLUSIONS Excellent graft and patient survival can be achieved in recipients of BxDL grafts. Notably, as demonstrated by the lack of effect of macrosteatosis on survival, Donor to recipient matching may contribute to these outcomes.

  • modeling the economic benefit of targeted mild hypothermia in deceased Donor kidney transplantation
    2019
    Co-Authors: David A Axelrod, Madhukar S Patel, Darren Malinoski, Tahnee Groat, Kristine Broglio, Roger J Lewis, Krista L Lentine, Mark A Schnitzler, Claus U Niemann
    Abstract:

    Delayed graft function (DGF) in kidney transplant significantly increases inpatient and outpatient cost. Targeted, mild hypothermia in organ Donors after neurologic determination of death significantly reduced the rate of DGF in a recent randomized controlled clinical trial. To assess the potential economic benefit of national implementation of Donor hypothermia, rates of reduction DGF were combined with estimates of the impact of DGF on hospital cost and total health expenditure for standard and extended criteria Donor organs (SCD and ECD). DGF increases the cost of the transplant episode by $9487 for ECD transplant and $10 342 for SCD transplant. Medicare recipients with DGF incur an additional $18 513 spending for ECD and $14 948 in SCD transplants over the first year. An absolute reduction in DGF rate after kidney transplantation consistent with trial results (ECD 25%, SCD 7%) has the potential to lower annual hospital cost for kidney transplant by $13 178 746 and annual Medicare spending by $20 970 706 compared to standard Donor Management practice using static cold storage. Targeted mild hypothermia improves care of renal transplant patients by safely reducing DGF rates in both ECD and SCD transplant. Broader application of this safe, effective, and low-cost intervention could reduce healthcare expenditures for providers and insurers.

  • current practices in deceased organ Donor Management
    2019
    Co-Authors: Madhukar S Patel, Peter L Abt
    Abstract:

    Purpose of reviewOptimizing the Management of deceased organ Donors focuses on providing critical care that prevents, mitigates, or repairs the pathophysiologic sequelae of brain death. This review discusses protocol-based care; approaches to monitoring, resuscitation, hormone replacement therapy, a

Darren Malinoski - One of the best experts on this subject based on the ideXlab platform.

  • vasopressor selection during critical care Management of brain dead organ Donors and the effects on kidney graft function
    2020
    Co-Authors: Elizabeth A Swanson, Madhukar S Patel, Claus U Niemann, Darren Malinoski, Tahnee Groat, Nora E Jameson, Margaret Katherine Ellis, Michael P Hutchens, Mitchell B Sally
    Abstract:

    Background Delayed graft function (DGF), the need for dialysis in the first week following kidney transplant, affects approximately one quarter of deceased-Donor kidney transplant recipients. Donor demographics, Donor serum creatinine, and graft cold ischemia time are associated with DGF. However, there is no consensus on the optimal Management of hemodynamic instability in organ Donors after brain death (DBDs). Our objective was to determine the relationship between vasopressor selection during Donor Management and the development of DGF. Methods Prospective observational data, including demographic and critical care parameters, were collected for all DBDs managed by 17 organ procurement organizations from nine Organ Procurement and Transplantation Network Regions between 2012 and 2018. Recipient outcome data were linked with Donor data through Donor identification numbers. Donor critical care parameters, including type of vasopressor and doses, were recorded at three standardized time points during Donor Management. The analysis included only Donors who received at least one vasopressor at all three time points. Vasopressor doses were converted to norepinephrine equivalent doses and analyzed as continuous variables. Univariate analyses were conducted to determine the association between Donor variables and DGF. Results were adjusted for known predictors of DGF using binary logistic regression. Results Complete data were available for 5,554 kidney transplant recipients and 2,985 DBDs. On univariate analysis, Donor serum creatinine, Donor age, Donor subtype, kidney Donor profile index, graft cold ischemia time, phenylephrine dose, and dopamine dose were associated with DGF. After multivariable analysis, increased Donor serum creatinine, Donor age, kidney Donor profile index, graft cold ischemia time, and phenylephrine dose remained independent predictors of DGF. Conclusion Higher doses of phenylephrine were an independent predictor of DGF. With the exception of phenylephrine, the selection and dose of vasopressor during Donor Management did not predict the development of DGF. Level of evidence Prognostic study, Level III.

  • state of the science in deceased organ Donor Management
    2018
    Co-Authors: Madhukar S Patel, Claus U Niemann, Mitchell B Sally, Darren Malinoski
    Abstract:

    Research in deceased organ Donor Management offers an opportunity to increase the quantity and quality of organs available for transplantation. This article aims to appraise the current literature with a focus on reviewing deceased Donor intervention trials. Aggressive critical care Management after determination of brain death resulting in meeting of a Donor Management goal bundle has consistently demonstrated an association with significantly more organs transplanted per Donor as well as improved graft outcomes. Although there is a dearth of experience with randomized Donor intervention studies, dopamine and targeted mild therapeutic hypothermia have been found to significantly reduce delayed graft function in kidney recipients. Progress in understanding the ethical, legal, regulatory, policy, and organizational elements of organ Donor research has provided a mechanism that allows for the endorsement of potentially impactful Donor Management studies. Ongoing trials should incorporate methods to ensure safety to all organs donated from Donors enrolled in interventional trials.

  • deceased organ Donor Management does hospital volume matter
    2017
    Co-Authors: Madhukar S Patel, Mitchell B Sally, Darren Malinoski, Tahnee Groat, Jahan Mohebali, Parsia A Vagefi, David C Chang
    Abstract:

    Background Identification of strategies to improve organ Donor use remains imperative. Despite the association between hospital volume and outcomes for many common disease processes, there have been no studies that assess the impact of organ Donor hospital volume on organ yield. Study Design A prospective observational study of all deceased organ Donors managed by 10 organ procurement organizations across United Network for Organ Sharing regions 4, 5, and 6 was conducted from February 2012 to June 2015. To study the impact of hospital volume on organ yield, each Donor was placed into a hospital-volume quartile based on the number of Donors managed by their hospital. Stepwise logistic regression was used to identify the independent effect of hospital volume on the primary outcomes measure of having ≥4 organs transplanted per Donor. Results Data from 4,427 Donors across 384 hospitals were collected and hospitals were assigned quartiles based on their volume of deceased Donors. Hospitals managed a mean ± SD of 3.3 ± 5.2 Donors per hospital per year. After adjusting for age, ethnicity, Donor type, blood type, BMI, creatinine, and organ procurement organization/Donor service area, being managed in hospitals within the highest volume quartile remained a positive independent predictor of ≥4 organs transplanted per Donor (odds ratio = 1.52; 95% CI 1.29 to 1.79; p Conclusions Deceased organ Donor hospital volume impacts organ yield, with the highest-volume centers being 52% more likely to achieve ≥4 organs transplanted per Donor. Efforts should be made to share practices from these higher-volume centers and consideration should be given to centralization of Donor care.

  • the impact of hydroxyethyl starch use in deceased organ Donors on the development of delayed graft function in kidney transplant recipients a propensity adjusted analysis
    2015
    Co-Authors: Madhukar S Patel, Claus U Niemann, Mitchell B Sally, S De La Cruz, J Zatarain, Tyler Ewing, Megan Crutchfield, C K Enestvedt, Darren Malinoski
    Abstract:

    Our objective was to evaluate the impact of hydroxyethyl starch (HES) use in organ Donors after neurologic determination of death (DNDD) on recipient renal graft outcomes. The following data elements were prospectively collected for every DNDD managed by a single organ procurement organization from June 2011 to July 2013: demographics; critical care endpoints; treatments, including the use of HES; graft cold ischemia time (CIT); and the occurrence of recipient delayed graft function (DGF, dialysis in the first week after transplantation). Logistic regression was performed to identify independent predictors of DGF with a p-value <0.05. The results were then adjusted for each Donor's calculated propensity to receive HES. Nine hundred eighty-six kidneys were transplanted from 529 Donors. Forty-two percent received HES (1217 ± 528 mL) and 35% developed DGF. Kidneys from DNDDs who received HES had a higher crude rate of DGF (41% vs. 31%, p < 0.001). After accounting for the propensity to receive HES, independent predictors of DGF were age (OR 1.02 [1.01–1.04] per year), CIT (OR 1.04[1.02–1.06] per hour), creatinine (OR 1.5 [1.32–1.72] per mg/dL) and HES use (OR 1.41 [1.02–1.95]). HES use during Donor Management was independently associated with a 41% increase in the risk of DGF in kidney transplant recipients.

  • determining optimal threshold for glucose control in organ Donors after neurologic determination of death a united network for organ sharing region 5 Donor Management goals workgroup prospective analysis
    2014
    Co-Authors: Mitchell B Sally, Madhukar S Patel, J Zatarain, Tyler Ewing, Megan Crutchfield, Salvador De La Cruz, Shariq S Raza, Darren Malinoski
    Abstract:

    BACKGROUNDThe appropriate level of glucose control in organ Donors after neurologic determination of death (DNDD) remains uncertain. We hypothesized that a glucose target of 180 mg/dL would be appropriate for optimizing organ transplantation rates and outcomes.METHODSDemographic, critical care, orga

Darren Malinoski - One of the best experts on this subject based on the ideXlab platform.

  • impact of deceased Donor Management on Donor heart use and recipient graft survival
    2020
    Co-Authors: Elizabeth A Swanson, Madhukar S Patel, Claus U Niemann, Mitchell B Sally, Kiran K Khush, Tony Adams, Salvador De La Cruz, Michael Hutchens, Tahnee Groat, Darren Malinoski
    Abstract:

    Background Current risk-adjusted models used to predict Donor heart use and cardiac graft survival from organ Donors after brain death (DBDs) do not include bedside critical care data. We sought to identify novel independent predictors of heart use and graft survival to better understand the relationship between Donor Management and transplantation outcomes. Study Design We conducted a prospective observational study of DBDs managed from 2008 to 2013 by 10 organ procurement organizations. Demographic data, critical care parameters, and treatments were recorded at 3 standardized time points during Donor Management. The primary outcomes measures were Donor heart use and cardiac graft survival. Results From 3,433 DBDs, 1,134 hearts (33%) were transplanted and 969 cardiac grafts (85%) survived after 684 ± 392 days of follow-up. After multivariable analysis, independent positive predictors of heart use included standard criteria Donor status (odds ratio [OR] 3.93), male sex (OR 1.68), ejection fraction > 50% (OR 1.64), and partial pressure of oxygen to fraction of inspired oxygen ratio > 300 (OR 1.31). Independent negative predictors of heart use included Donor age (OR 0.94), BMI > 30 kg/m2 (OR 0.78), serum creatinine (OR 0.83), and use of thyroid hormone (OR 0.78). As for graft survival, after controlling for known recipient risk factors, thyroid hormone dose was the only independent predictor (OR 1.04 per μg/h). Conclusions Modifiable critical care parameters and treatments predict Donor heart use and cardiac graft survival. The discordant relationship between thyroid hormone and Donor heart use (negative predictor) vs cardiac graft survival (positive predictor) warrants additional investigation.

  • the role of deceased Donor liver biopsy an analysis of 5449 liver transplant recipients
    2020
    Co-Authors: Madhukar S Patel, Claus U Niemann, Mitchell B Sally, Darren Malinoski, Tahnee Groat, Jahan Mohebali, Taylor M Coe, Parsia A Vagefi
    Abstract:

    BACKGROUND No standard exists for the use of deceased Donor liver biopsy during procurement. We sought to evaluate liver biopsy and the impact of findings on outcomes and graft utilization. METHODS A prospective observational study of Donors after neurologic determination of death was conducted from 02/2012-08/2017 (16 OPOs). Donor data were collected through the UNOS Donor Management Goals Registry Web Portal and linked to the Scientific Registry of Transplant Recipients (SRTR) for recipient outcomes. Recipients of biopsied Donor livers (BxDL) were studied and a Cox proportional hazard analysis was used to identify independent predictors of 1-year graft survival. RESULTS Data from 5449 liver transplant recipients were analyzed, of which 1791(33%) received a BxDL. There was no difference in graft or patient survival between the non-BxDL and BxDL recipient groups. On adjusted analysis of BxDL recipients, macrosteatosis (21%-30%[n = 148] and >30%[n = 92]) was not found to predict 1-year graft survival, whereas increasing Donor age (HR1.02), Donor Hispanic ethnicity (HR1.62), Donor INR (HR1.18), and recipient life support (HR2.29) were. CONCLUSIONS Excellent graft and patient survival can be achieved in recipients of BxDL grafts. Notably, as demonstrated by the lack of effect of macrosteatosis on survival, Donor to recipient matching may contribute to these outcomes.

  • modeling the economic benefit of targeted mild hypothermia in deceased Donor kidney transplantation
    2019
    Co-Authors: David A Axelrod, Madhukar S Patel, Darren Malinoski, Tahnee Groat, Kristine Broglio, Roger J Lewis, Krista L Lentine, Mark A Schnitzler, Claus U Niemann
    Abstract:

    Delayed graft function (DGF) in kidney transplant significantly increases inpatient and outpatient cost. Targeted, mild hypothermia in organ Donors after neurologic determination of death significantly reduced the rate of DGF in a recent randomized controlled clinical trial. To assess the potential economic benefit of national implementation of Donor hypothermia, rates of reduction DGF were combined with estimates of the impact of DGF on hospital cost and total health expenditure for standard and extended criteria Donor organs (SCD and ECD). DGF increases the cost of the transplant episode by $9487 for ECD transplant and $10 342 for SCD transplant. Medicare recipients with DGF incur an additional $18 513 spending for ECD and $14 948 in SCD transplants over the first year. An absolute reduction in DGF rate after kidney transplantation consistent with trial results (ECD 25%, SCD 7%) has the potential to lower annual hospital cost for kidney transplant by $13 178 746 and annual Medicare spending by $20 970 706 compared to standard Donor Management practice using static cold storage. Targeted mild hypothermia improves care of renal transplant patients by safely reducing DGF rates in both ECD and SCD transplant. Broader application of this safe, effective, and low-cost intervention could reduce healthcare expenditures for providers and insurers.

  • organ donation education initiatives a report of the Donor Management task force
    2016
    Co-Authors: Christopher P Michetti, Darren Malinoski, Thomas A Nakagawa, Charles Wright, Le Ann Swanson
    Abstract:

    Abstract Purpose It is essential that hospitals and health professionals establish systems to facilitate patients' organ donation wishes. Donation education has been neither standardized nor systematic, and resources related to donation processes have not been widely accessible. This report describes 2 free, publicly available educational resources about the organ donation process created to advance the mission of basic education and improve donation processes within hospitals and health care systems. Materials and methods Members of the Donor Management Task Force of the Organ Donation and Transplantation Alliance (the Alliance) and the Health Resources and Services Administration of the US Department of Health and Human Services convened annually in person and by teleconferencing during the year to develop 2 educational vehicles on organ donation. Results Two educational products were developed: the Organ Donation Toolbox, an online repository of documents and resources covering all aspects of the donation process, and the Educational Training Video that reviews the basic foundations of a successful hospital donation system. Conclusions There is a need for more research and education about the process of organ donation as it relates to the medical and psychosocial care of patients and families before the end of life. The educational products described can help fill this critical need.

  • Management of the potential organ Donor in the icu society of critical care medicine american college of chest physicians association of organ procurement organizations consensus statement
    2015
    Co-Authors: Robert M Kotloff, Darren Malinoski, Luis F Angel, Sandralee Blosser, Gerard J Fulda, Vivek N Ahya, Matthew C Byrnes, Michael A Devita, Thomas E Grissom, Scott D Halpern
    Abstract:

    This document was developed through the collaborative efforts of the Society of Critical Care Medicine, the American College of Chest Physicians, and the Association of Organ Procurement Organizations. Under the auspices of these societies, a multidisciplinary, multi-institutional task force was convened, incorporating expertise in critical care medicine, organ Donor Management, and transplantation. Members of the task force were divided into 13 subcommittees, each focused on one of the following general or organ-specific areas: death determination using neurologic criteria, donation after circulatory death determination, authorization process, general contraindications to donation, hemodynamic Management, endocrine dysfunction and hormone replacement therapy, pediatric Donor Management, cardiac donation, lung donation, liver donation, kidney donation, small bowel donation, and pancreas donation. Subcommittees were charged with generating a series of Management-related questions related to their topic. For each question, subcommittees provided a summary of relevant literature and specific recommendations. The specific recommendations were approved by all members of the task force and then assembled into a complete document. Because the available literature was overwhelmingly comprised of observational studies and case series, representing low-quality evidence, a decision was made that the document would assume the form of a consensus statement rather than a formally graded guideline. The goal of this document is to provide critical care practitioners with essential information and practical recommendations related to Management of the potential organ Donor, based on the available literature and expert consensus.

Mitchell B Sally - One of the best experts on this subject based on the ideXlab platform.

  • impact of deceased Donor Management on Donor heart use and recipient graft survival
    2020
    Co-Authors: Elizabeth A Swanson, Madhukar S Patel, Claus U Niemann, Mitchell B Sally, Kiran K Khush, Tony Adams, Salvador De La Cruz, Michael Hutchens, Tahnee Groat, Darren Malinoski
    Abstract:

    Background Current risk-adjusted models used to predict Donor heart use and cardiac graft survival from organ Donors after brain death (DBDs) do not include bedside critical care data. We sought to identify novel independent predictors of heart use and graft survival to better understand the relationship between Donor Management and transplantation outcomes. Study Design We conducted a prospective observational study of DBDs managed from 2008 to 2013 by 10 organ procurement organizations. Demographic data, critical care parameters, and treatments were recorded at 3 standardized time points during Donor Management. The primary outcomes measures were Donor heart use and cardiac graft survival. Results From 3,433 DBDs, 1,134 hearts (33%) were transplanted and 969 cardiac grafts (85%) survived after 684 ± 392 days of follow-up. After multivariable analysis, independent positive predictors of heart use included standard criteria Donor status (odds ratio [OR] 3.93), male sex (OR 1.68), ejection fraction > 50% (OR 1.64), and partial pressure of oxygen to fraction of inspired oxygen ratio > 300 (OR 1.31). Independent negative predictors of heart use included Donor age (OR 0.94), BMI > 30 kg/m2 (OR 0.78), serum creatinine (OR 0.83), and use of thyroid hormone (OR 0.78). As for graft survival, after controlling for known recipient risk factors, thyroid hormone dose was the only independent predictor (OR 1.04 per μg/h). Conclusions Modifiable critical care parameters and treatments predict Donor heart use and cardiac graft survival. The discordant relationship between thyroid hormone and Donor heart use (negative predictor) vs cardiac graft survival (positive predictor) warrants additional investigation.

  • vasopressor selection during critical care Management of brain dead organ Donors and the effects on kidney graft function
    2020
    Co-Authors: Elizabeth A Swanson, Madhukar S Patel, Claus U Niemann, Darren Malinoski, Tahnee Groat, Nora E Jameson, Margaret Katherine Ellis, Michael P Hutchens, Mitchell B Sally
    Abstract:

    Background Delayed graft function (DGF), the need for dialysis in the first week following kidney transplant, affects approximately one quarter of deceased-Donor kidney transplant recipients. Donor demographics, Donor serum creatinine, and graft cold ischemia time are associated with DGF. However, there is no consensus on the optimal Management of hemodynamic instability in organ Donors after brain death (DBDs). Our objective was to determine the relationship between vasopressor selection during Donor Management and the development of DGF. Methods Prospective observational data, including demographic and critical care parameters, were collected for all DBDs managed by 17 organ procurement organizations from nine Organ Procurement and Transplantation Network Regions between 2012 and 2018. Recipient outcome data were linked with Donor data through Donor identification numbers. Donor critical care parameters, including type of vasopressor and doses, were recorded at three standardized time points during Donor Management. The analysis included only Donors who received at least one vasopressor at all three time points. Vasopressor doses were converted to norepinephrine equivalent doses and analyzed as continuous variables. Univariate analyses were conducted to determine the association between Donor variables and DGF. Results were adjusted for known predictors of DGF using binary logistic regression. Results Complete data were available for 5,554 kidney transplant recipients and 2,985 DBDs. On univariate analysis, Donor serum creatinine, Donor age, Donor subtype, kidney Donor profile index, graft cold ischemia time, phenylephrine dose, and dopamine dose were associated with DGF. After multivariable analysis, increased Donor serum creatinine, Donor age, kidney Donor profile index, graft cold ischemia time, and phenylephrine dose remained independent predictors of DGF. Conclusion Higher doses of phenylephrine were an independent predictor of DGF. With the exception of phenylephrine, the selection and dose of vasopressor during Donor Management did not predict the development of DGF. Level of evidence Prognostic study, Level III.

  • the role of deceased Donor liver biopsy an analysis of 5449 liver transplant recipients
    2020
    Co-Authors: Madhukar S Patel, Claus U Niemann, Mitchell B Sally, Darren Malinoski, Tahnee Groat, Jahan Mohebali, Taylor M Coe, Parsia A Vagefi
    Abstract:

    BACKGROUND No standard exists for the use of deceased Donor liver biopsy during procurement. We sought to evaluate liver biopsy and the impact of findings on outcomes and graft utilization. METHODS A prospective observational study of Donors after neurologic determination of death was conducted from 02/2012-08/2017 (16 OPOs). Donor data were collected through the UNOS Donor Management Goals Registry Web Portal and linked to the Scientific Registry of Transplant Recipients (SRTR) for recipient outcomes. Recipients of biopsied Donor livers (BxDL) were studied and a Cox proportional hazard analysis was used to identify independent predictors of 1-year graft survival. RESULTS Data from 5449 liver transplant recipients were analyzed, of which 1791(33%) received a BxDL. There was no difference in graft or patient survival between the non-BxDL and BxDL recipient groups. On adjusted analysis of BxDL recipients, macrosteatosis (21%-30%[n = 148] and >30%[n = 92]) was not found to predict 1-year graft survival, whereas increasing Donor age (HR1.02), Donor Hispanic ethnicity (HR1.62), Donor INR (HR1.18), and recipient life support (HR2.29) were. CONCLUSIONS Excellent graft and patient survival can be achieved in recipients of BxDL grafts. Notably, as demonstrated by the lack of effect of macrosteatosis on survival, Donor to recipient matching may contribute to these outcomes.

  • state of the science in deceased organ Donor Management
    2018
    Co-Authors: Madhukar S Patel, Claus U Niemann, Mitchell B Sally, Darren Malinoski
    Abstract:

    Research in deceased organ Donor Management offers an opportunity to increase the quantity and quality of organs available for transplantation. This article aims to appraise the current literature with a focus on reviewing deceased Donor intervention trials. Aggressive critical care Management after determination of brain death resulting in meeting of a Donor Management goal bundle has consistently demonstrated an association with significantly more organs transplanted per Donor as well as improved graft outcomes. Although there is a dearth of experience with randomized Donor intervention studies, dopamine and targeted mild therapeutic hypothermia have been found to significantly reduce delayed graft function in kidney recipients. Progress in understanding the ethical, legal, regulatory, policy, and organizational elements of organ Donor research has provided a mechanism that allows for the endorsement of potentially impactful Donor Management studies. Ongoing trials should incorporate methods to ensure safety to all organs donated from Donors enrolled in interventional trials.

  • deceased organ Donor Management does hospital volume matter
    2017
    Co-Authors: Madhukar S Patel, Mitchell B Sally, Darren Malinoski, Tahnee Groat, Jahan Mohebali, Parsia A Vagefi, David C Chang
    Abstract:

    Background Identification of strategies to improve organ Donor use remains imperative. Despite the association between hospital volume and outcomes for many common disease processes, there have been no studies that assess the impact of organ Donor hospital volume on organ yield. Study Design A prospective observational study of all deceased organ Donors managed by 10 organ procurement organizations across United Network for Organ Sharing regions 4, 5, and 6 was conducted from February 2012 to June 2015. To study the impact of hospital volume on organ yield, each Donor was placed into a hospital-volume quartile based on the number of Donors managed by their hospital. Stepwise logistic regression was used to identify the independent effect of hospital volume on the primary outcomes measure of having ≥4 organs transplanted per Donor. Results Data from 4,427 Donors across 384 hospitals were collected and hospitals were assigned quartiles based on their volume of deceased Donors. Hospitals managed a mean ± SD of 3.3 ± 5.2 Donors per hospital per year. After adjusting for age, ethnicity, Donor type, blood type, BMI, creatinine, and organ procurement organization/Donor service area, being managed in hospitals within the highest volume quartile remained a positive independent predictor of ≥4 organs transplanted per Donor (odds ratio = 1.52; 95% CI 1.29 to 1.79; p Conclusions Deceased organ Donor hospital volume impacts organ yield, with the highest-volume centers being 52% more likely to achieve ≥4 organs transplanted per Donor. Efforts should be made to share practices from these higher-volume centers and consideration should be given to centralization of Donor care.

Ali Salim - One of the best experts on this subject based on the ideXlab platform.

  • impact of deceased organ Donor demographics and critical care end points on liver transplantation and graft survival rates
    2015
    Co-Authors: Matthew B Bloom, Madhukar S Patel, Tyler Ewing, Ali Salim, Shariq S Raza, Akash Bhakta, Eric J Ley, Daniel R Margulies, Darren Malinoski
    Abstract:

    Background The criteria for organ acceptance remain inconsistent, which limits the ability to standardize critical care practices. We sought to examine predictors of liver graft use and survival to better guide the selection and Management of potential organ Donors. Study Design A prospective observational study of all Donors managed by the 8 organ procurement organizations in United Network for Organ Sharing Region 5 was conducted from July 2008 to March 2011. Critical care end points that reflect the normal hemodynamic, acid−base, respiratory, endocrine, and renal status of the Donor were collected at 3 time points. Critical care and demographic data associated with liver transplantation and graft survival rates were first determined using univariate analyses, and then logistic regression was used to identify independent predictors of these two outcomes. Results From 961 Donors, 730 (76%) livers were transplanted and 694 (95%) were functioning after 74 ± 73 days of follow-up. After regression analysis, Donor BMI (odds ratio [OR] = 0.94), male sex (OR = 1.89), glucose 50% (OR = 1.77) remained as independent predictors of liver use. Graft survival was associated with lower Donor BMI (OR = 0.91) and sodium levels (OR = 0.95). Conclusions After controlling for Donor age, sex, and BMI, both hemodynamic and endocrine critical care end points were associated with increased liver graft use. Both Donor BMI and lower sodium levels during the course of Donor Management were independently predictive of improved graft survival. These results may help guide the Management and selection of potential organ Donors after neurologic determination of death.

  • the impact of meeting Donor Management goals on the development of delayed graft function in kidney transplant recipients
    2013
    Co-Authors: Darren Malinoski, Madhukar S Patel, Michael C Daly, Clarence E Foster, O Ahmed, S Mooney, C O Graybill, Ali Salim
    Abstract:

    Many organ procurement organizations (OPOs) utilize preset critical care endpoints as Donor Management goals (DMGs) in order to standardize care and improve outcomes. The objective of this study was to determine the impact of meeting DMGs on delayed graft function (DGF) in renal transplant recipients. All eight OPOs of the United Network for Organ Sharing Region 5 prospectively implemented nine DMGs in every Donor after neurologic determination of death (DNDD). “DMGs met” was defined a priori as achieving any seven of the nine DMGs and this was recorded at the time of consent for donation to reflect Donor hospital ICU Management, 12–18 h later, and prior to organ recovery. Multivariable analyses were performed to identify independent predictors of DGF (dialysis in the first week after transplantation) with a p < 0.05. A total of 722 transplanted kidneys from 492 DNDDs were included. A total of 28% developed DGF. DMGs were met at consent in 14%, 12–18 h in 32% and prior to recovery in 38%. DGF was less common when DMGs were met at consent (17% vs. 30%, p = 0.007). Independent predictors of DGF were age, Cr and cold ischemia time, while meeting DMGs at consent was significantly protective. The Management of potential organ Donors prior to consent affects outcomes and should remain a priority in the intensive care unit.

  • the impact of meeting Donor Management goals on the number of organs transplanted per Donor results from the united network for organ sharing region 5 prospective Donor Management goals study
    2012
    Co-Authors: Darren Malinoski, Madhukar S Patel, Michael C Daly, Chrystal Oleygraybill, Ali Salim
    Abstract:

    Objective:Many organ procurement organizations have implemented critical care end points as Donor Management goals in efforts to increase organs transplanted per Donor after neurologic determination of death. Although retrospective studies have demonstrated an association between meeting Donor manag

  • achieving Donor Management goals before deceased Donor procurement is associated with more organs transplanted per Donor
    2011
    Co-Authors: Darren Malinoski, Madhukar S Patel, Michael C Daly, Chrystal Oleygraybill, Clarence E Foster, Ali Salim
    Abstract:

    Background:There is a national shortage of organs available for transplantation. Implementation of preset Donor Management goals (DMGs) to improve outcomes is recommended, but uniform practices and data are lacking. We hypothesized that meeting DMGs before organ procurement would result in more orga

  • aggressive organ Donor Management protocol
    2008
    Co-Authors: Joseph J Dubose, Ali Salim
    Abstract:

    As of August 2007, 96 900 people are awaiting organ transplantation in the United States, while only 28 930 transplants were performed in 2006. With such a large gap between organ need and organ availability, it is inevitable that many will die while awaiting transplantation. This organ shortage has become a national public health crisis, and as a response, the United States Department of Health and Human Services launched the Organ Donation Breakthrough Collaborative, an ambitious campaign to dramatically increase the number of transplantable organs. One of the suggested strategies involves maximizing the number of organs obtained from the available cadaveric ``brain dead'' Donor pool by using Donor Management protocols that optimize and treat the profound physiological disturbances that are associated with brain death. The use of these standardized and aggressive Donor Management protocols has been shown to increase the number of transplanted organs and prevent the number of Donors lost due to medical f...