UCSF Research Team Shows that Mild Hypothermia in Deceased Organ Donors Improves Function in Kidney Transplant Recipients
UCSF News reports on a just published study in the The New England Journal of Medicine in which mild hypothermia in deceased organ donors was found to significantly reduce delayed graft function in kidney transplant recipients compared with normal body temperature. The lead author of the study is Claus Niemann, MD, Professor of Anesthesia and Surgery at UCSF, and co-Director of the Ischemic Organ Injury Lab. The findings in the study could lead to an increase in the availability of kidneys for transplant.
Mild hypothermia in deceased organ donors significantly reduces delayed graft function in kidney transplant recipients when compared to normal body temperature, according to UC San Francisco researchers and collaborators, a finding that could lead to an increase in the availability of kidneys for transplant.
Their study appears in the July 30 issue of the New England Journal of Medicine.
By passively cooling deceased organ donor body temperature by approximately two degrees from normal body temperature, researchers saw an overall nearly 40 percent increase in the successful function of donated kidneys after surgery. In particular, kidneys especially at risk of poor post-surgical functional were protected.
“This is a free intervention that can be done at any hospital in the world, and tens of thousands of patients worldwide can benefit from it,” said lead author Claus Niemann, MD, professor of anesthesia and surgery at UCSF.
“It could have a major impact on global health, especially in resource-limited countries, and provide significant cost savings in the United States through less dialysis, shorter hospital stays and potentially less need for expensive interventions,” Niemann continued. “In addition, it may allow us to consider organs we may otherwise reject, especially at the extremes of age, which would result in more patients benefiting from kidney transplantation. This is of critical importance given we have a complete mismatch of transplant need and organ supply in the United States.”
Therapeutic hypothermia (targeted temperature management) is an established intervention for certain types of cardiac arrest, stroke and asphyxia patients and is used to protect neurological function, but its impact on renal protection in the transplantation setting has been unknown, according to the researchers. Current organ donor management protocols stipulate normal body temperature be maintained in donors, frequently requiring active warming.
However, delayed organ function after kidney transplantation is reported in up to 40 percent of recipients and associated with increased cost and diminished long-term organ function............
Other contributors to the NEJM study were senior author and researcher Darren Malinoski, MD, VA Portland Health Care System and Oregon Health & Science University; John Feiner, MD, professor of anesthesia, Ryutaro Hirose, MD, professor of surgery, and John Roberts, MD, professor of surgery and transplant service chief, of UCSF; Sharon Swain, MSN, RN, California Transplant Donor Network (now Donor Network West); Scott Bunting, RRT, and Melissa Friedman, MSN, RN, of OneLegacy; Megan Crutchfield, MPH, VA Portland Health Care System; and Kristine Broglio, MS, Berry Consultants LLC. Funding was provided by the U.S. Department of Health and Human Services Health Resources and Services Administration.