NEJM: "Therapeutic Hypothermia in Deceased Organ Donors and Kidney-Graft Function"

The following insert was taken from The New England Journal of Medicine article, "Therapeutic Hypothermia in Deceased Organ Donors and Kidney-Graft Function".

BACKGROUND

"Delayed graft function, which is defined as the requirement for dialysis in the recipient within 7 days after renal transplantation, results in increased health care expenditures and decreased long-term graft function. Delayed graft function is reported in up to 50% of renal allografts recovered from donors after declaration of death according to neurologic criteria (brain-dead donors). Randomized, controlled trials to study the effect of therapeutic hypothermic protection in donors on renal-graft function in transplant recipients are lacking.

Therapeutic hypothermia, also termed targeted temperature management, is an established intervention that is used to protect neurologic function in patients with certain types of cardiac arrest, stroke, and asphyxia. The effect of therapeutic hypothermia on renal protection is uncertain. However, in a retrospective study involving patients with cardiac arrest, mild hypothermia appeared to protect against renal injury. An experimental study involving rabbits showed that rapid cooling to moderate hypothermia preserved renal function during cardiac arrest. A review article summarized the mechanisms for benefit with hypothermia; these include reduced metabolism and reduction of free-radical production.

Current protocols stipulate that normothermia, which frequently requires active warming, be maintained in organ donors. The effect of targeted hypothermia as an intervention to protect renal function during the donation process is uncertain. We therefore conducted a prospective, randomized, controlled trial in two large organ-donation service areas to test the potential benefit and safety of targeted hypothermia in donors with respect to rates of delayed graft function among the recipients of their kidneys."

Full Article Text

Niemann CU, Feiner J, Swain S, et al. Therapeutic hypothermia in deceased organ donors and kidney-graft function. N Engl J Med 2015;373:405-414