The Impact of Duration of Brain Death on Outcomes in Abdominal Organ Transplantation: Rush and Retrieve or Relax and Repair 2017? A Retrospective UK Transplant Registry Analysis

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Abstract

Background

Brain death (BD) induces a profound inflammatory response affecting the quality and function of donor organs. Longer BD duration increases injury in donor organs, but up-regulation of defence mechanisms also occurs, initiating regeneration and repair. This poses the question what is better for the graft-to-be: retrieval of the organs as-soon-as-possible or wait and optimise in-situ repair?

Methods

A retrospective analysis of the UK transplant registry evaluated donors after brain death DBD donors during 2008-2012. In 1881 donors the relationship between BD duration and function or graft-survival at 1 and 3-years was analysed using multivariate and Cox regression analyses of 2815 kidneys, 1555 livers and 588 pancreata.

Results

Longer BD duration did not have a detrimental association with liver transplant survival (p = 0.89, 1 yr survival), whilst in fact prolonged BD duration was associated with increased transplant survival following first kidney-only transplantation (p = 0.02, 1 yr survival) for prolonged cold ischaemic time (18-24 hours) and following pancreas transplantation (p < 0.0001, 1 yr survival) in recent years. Although delayed graft function was more common in kidney transplants as the duration of BD increased (p < 0.0001), there was no association with primary non-function (p = 0.62). Longer BD duration had no detrimental association with graft function at 1 year when the donor was 30 years or older and was associated with increased graft function for donors aged 30 to 40 years (p = 0.01).

Discussion

This demonstrates that prolonged BD is not detrimental to outcomes in abdominal organ transplantation. This finding supports that time for donor management may be effectively used to adequately optimise donor organs. This analysis renounces the need for a ‘Rush and Retrieve’ policy and suggests that the DBD environment may be less ‘hostile’ than is perceived, allowing sufficient time to support repair through targeted intervention prior to organ retrieval.

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