Managing Expectations of Prolonged Warm Ischemia Time: A Calculator to Predict Donation After Circulatory Death Donor Progression to Circulatory Death Within 30 Min

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-10-06 DOI:10.1111/ctr.70336

Yanik J. Bababekov, Carlos Goncalves, Anna H. Ha, Tiffany E. Maksimuk, John S. Malamon, Arthur Yule, David Y. Chen, Jordan R. H. Hoffman, Jesse D. Schold, Elizabeth A. Pomfret, Bruce Kaplan, James J. Pomposelli

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Abstract

Background

Transplant teams may be better prepared to entertain DCD offers with a priori prediction of prolonged warm ischemia time (WIT) and deploy perfusion strategies (PS) to mitigate the risk of WIT.

Methods

All potential adult Maastricht-III DCDs in one Organ Procurement Organization from January 2016 to July 2024 were reviewed. Data were obtained from UNOS DonorNet. Cases with missing variables were excluded. The most recent clinical values prior to withdrawal of life support treatment (WLST) were utilized. Logistic regression assessed the likelihood of DCD progression within 30 min after WLST.

Results

From a total of 748 potential DCDs, 350 were assessed after exclusion criteria. One hundred and seventy-one (49%) progressed within 30 min. Forty percent (n = 140) of the sample was used for training and 60% (n = 160) for validation. Potassium (OR: 3.01; 95% CI: [1.39, 6.5], p = 0.005), sodium (OR: 1.23; 95% CI: [1.01, 1.50], p = 0.036); body mass index (OR: 1.68; 95% CI: [1.39, 2.03], p = 0.0001) and heart rate (OR: 1.54; 95% CI: [1.24, 1.92], p = 0.0001) positively correlated with progression. Age (OR: 0.71; 95% CI: [0.58, 0.86], p = 0.0006); presence of pupillary reflexes (OR: 0.81; 95% CI:[0.68, 0.92], p = 0.007); presence of corneal reflexes (OR: 0.27; 95% CI: [0.22, 0.34], p = 0.001); and presence of overbreathing the ventilator (OR: 0.39; 95% CI: [0.32, 0.48], p = 0.001) negatively correlated with progression. Discrimination was excellent (NPV 89%; PPV 88%).

Conclusions

DonorNet variables predict progression to circulatory death within 30 min. If there is an indication that a DCD will not progress within a 30-min threshold, then early discussion of PS may decrease the risk of a dry run.

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延长热缺血时间的预期管理：预测循环性死亡后供体在30分钟内进展为循环性死亡的计算器

背景：通过延长热缺血时间（WIT）的先验预测和采用灌注策略（PS）来降低WIT的风险，移植团队可能会更好地准备接受DCD治疗。方法：回顾性分析某器官采购机构2016年1月至2024年7月所有潜在的成人马斯特里赫特iii型dcd。数据来自美国器官捐赠网。排除变量缺失的病例。使用生命支持治疗（WLST）停药前的最新临床值。Logistic回归评估WLST后30分钟内DCD进展的可能性。结果：从748例潜在的dcd中，经排除标准评估了350例。171例（49%）在30分钟内进展。40% （n = 140）的样本用于训练，60% （n = 160）的样本用于验证。钾(OR: 3.01; 95%置信区间CI: [1.39, 6.5], p = 0.005),钠(OR: 1.23; 95%置信区间CI: [1.01, 1.50], p = 0.036);体重指数（OR: 1.68; 95% CI: [1.39, 2.03], p = 0.0001）和心率（OR: 1.54; 95% CI: [1.24, 1.92], p = 0.0001）与病情进展呈正相关。年龄(OR: 0.71; 95%置信区间CI: [0.58, 0.86], p = 0.0006);瞳孔反射（OR: 0.81; 95% CI:[0.68, 0.92], p = 0.007）；存在角膜反射（OR: 0.27; 95% CI: [0.22, 0.34], p = 0.001）；呼吸机过度呼吸（OR: 0.39; 95% CI: [0.32, 0.48], p = 0.001）与病情进展呈负相关。鉴别性极好（NPV 89%; PPV 88%）。结论：DonorNet变量预测30分钟内进展为循环性死亡。如果有迹象表明DCD不会在30分钟的阈值内进展，那么早期讨论PS可能会降低预演的风险。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.