Dropping the temperature of a deceased organ donor by just 2 degrees C could improve efficiency of kidney transplantation, according to a new study published in the New England Journal of Medicine.
Cooling donor bodies could reduce the possibility of developing delayed graft function by 38 percent. A form of acute renal failure that often results in allograft immunogenicity, post-transplantation oliguria and risk of acute rejection episodes, delayed graft function can reduce long-term survival of recipients.
About 40 percent of all kidney transplant patients develop delayed graft function, which can diminish the long-term function of the graft and increase overall costs. Factors relating to both the donor and recipient can contribute to the development of delayed graft function, which requires dialysis within seven days of transplantation.
Any hospital in the world can perform this free intervention, which has the potential to benefit tens of thousands of patients. The procedure could potentially provide significant cost savings by shortening hospital stays, reducing the need for dialysis and avoiding expensive interventions.
The procedure, known as targeted temperature management or therapeutic hypothermia, is already in use for patients who have experienced stroke, asphyxia, or certain types of cardiac arrest. Therapeutic hypothermia helps preserve nervous system function in these patients. Researchers are less certain about the effects of hypothermia on renal function, although some studies suggest that mild to moderate hypothermia can help preserve function of these organs.
Currently, transplantation protocols require organ bodies to be at room temperature, which often requires active warming.
Furthermore, improving efficiency may allow doctors to consider organs they might otherwise reject, especially in very old and very young patients. This increases the number of organs available for transplantation, which results in a greater number of people benefiting from the procedure. The National Kidney Foundation says that more than 101,000 people are waiting for a kidney transplant; this procedure could drastically reduce that number.
In the study, Dr. Claus Niemann, professor of anesthesia and surgery at the University of California-San Francisco (UCSF), and his team of researchers conducted a randomized controlled trial. They enrolled 370 organ donors, assigning 190 to a normal body temperature group and 180 to a hypothermia group.
The researchers kept the bodies in the hypothermia group about 2 degrees C lower than the body temperature group, holding the donor bodies in the hypothermia group at 34 to 35 degrees C and the normothermia group at 36.5 to 37.5 degrees C. The researchers initiated the temperature protocols after obtaining authorization for organ donation and ended when the organ donors left the intensive care unit in preparation for organ recover in the operating room.
In this study, 572 patients received kidney transplants — 285 from donors in the hypothermia group and 287 from the normothermia group.
In the body temperature group, 112 patients (39 percent) developed delayed graft function. In comparison, only 79 patients (28 percent) who received kidneys from the hypothermia group developed the condition.
This study shows that mild hypothermia, rather than normothermia, after declaration of death in organ donors can significantly reduce the rate of delayed graft function in kidney transplant recipients.
