PURPOSE:The number of patients waiting for solid-organ transplantation in the United States exceeds 99,000 currently. Donor hemodynamic instability is common after brain death and renders many organs unsuitable for transplantation. Improved organs transplanted per donor (OTPD) would maximize organ yield from the existing donor pool. Whether achieving hemodynamic resuscitation targets and maintaining oxygen delivery (DO2I) to end-organs correlates with improved OTPD is unknown. We hypothesized that Ultrasound Cardiac Monitor (USCOM) guided hemodynamic resuscitation improves OTPD over standard care.
METHODS:Donors were randomly assigned to experimental (USCOM,n=39) or control(n=35) groups. Hemodynamic measurements were recorded at study entry and serially until organ procurement. Control patients were managed using OneLegacy donor management guidelines. In the experimental group, USCOM monitoring of CI, SVRI and SVI enabled targeting three specific hemodynamic parameters (CI 2.5–5, SVRI 1500–2400 and SVI 30–65). OTPD was compared between groups using 2-tailed independent t-test. Baseline and final D02I were correlated with Thyroxine (T4) infusion, vasopressor use, and OTPD utilizing Spearman’s rho test.
RESULTS:Study patients were 12 months to 67 years old. USCOM group OTPD was 15% higher (3.31 ± 2.1 control vs. 3.82 ± 1.3 experimental p=0.22). No correlation existed between vasopressor dose and DO2I. However, a positive correlation was found between T4 use and DO2I in the USCOM group (p<0.05), and improved DO2I and OTPD regardless of treatment group assignment. Mean OTPD for patients not meeting any of the three targeted hemodynamic parameters was 2.6; improved by 30% to 3.8 upon achieving any one (p<.05) and by 43% to 4.0 (p<.05) if 2 or all 3 were achieved. Increased case time correlated with improved OTPD (p<0.01).
CONCLUSION:USCOM guided hemodynamic management improved OTPD by 15% compared to controls, which is clinically relevant though not statistically significant. T4 infusion, combined with goal directed resuscitation improved DO2I. Better DO2I, meeting one or more predetermined hemodynamic goals and increased case times improve OTPD significantly.
CLINICAL IMPLICATIONS:Achieving targeted hemodynamic parameters may improve the number of transplantable organs procured from brain-dead organ donors.
DISCLOSURE:Mudit Mathur, No Financial Disclosure Information; No Product/Research Disclosure Information