부산대학교 도서관

Background: In controlled donation after circulatory determination of death (DCD), it is common to administer premortem heparin to potential donors. This practice remains controversial because there is limited evidence for it and there is the possibility of inducing hemorrhage. To our knowledge, no previous studies have assessed the effects of heparin timing and dose on graft function. Methods: We performed a multicentre cohort study of consecutive DCD donors and the recipients of their organs. Anti coagulation administration was considered early if given near the time of withdrawal of life-sustaining measures and late if delayed until the onset of donor hypoxemia (oxygen saturation < 70%) or hypotension (systolic blood pressure < 60 mm Hg or mean blood pressure < 50 mm Hg). The anticoagulation dose was considered high if it was 300 units/kg or greater. Results: Donor anticoagulation data were available for 301 kidney, 75 liver and 46 lung recipients. Heparin was administered in 92% of cases and was most commonly withheld in donors with cerebrovascular causes of death (p = 0.01). Administration was late in 59% and the dose was low in 27%. Among kidney recipients, there were no significant differences in need for dialysis, glomerular filtration rate over the first year after transplantation or graft survival on the basis of whether or not the donor received heparin, the timing of heparin administration or the dose of heparin. Among liver recipients, alkaline phosphatase concentrations over the first year were significantly higher among recipients who received organs from donors to whom lower doses of heparin had been administered. Conclusion: Premortem heparin is widely used in DCD cases, but there is variability in timing and dose, which was not associated with kidney outcomes in this study. Donor anticoagulation may have a greater impact in preventing biliary complications following liver transplantation. Contexte : Dans les cas de don controle apres un diagnostic de deces cardiorespiratoire (DDC), il est courant d'administrer de l'heparine aux donneurs potentiels avant le deces. Cette pratique demeure controversee faute de donnees probantes a l'appui et par son risque de declencher une hemorragie. A notre connaissance, il n'existe aucune etude ayant evalue les effets de la dose d'heparine et du moment de son administration sur la fonction du greffon. Methodes : Une etude de cohorte multicentrique a ete realisee sur des donneurs decedes apres un DDC et sur ceux qui ont recu leurs organes. L'administration d'anticoagulants etait consideree comme hative si elle avait lieu peu avant le retrait des mesures de maintien de la vie et tardive si elle etait repoussee a la survenue de l'hypoxemie (saturation en oxygene inferieure a 70 %) ou de l'hypotension (tension arterielle systolique inferieure a 60 mm Hg ou tension arterielle moyenne inferieure a 50 mm Hg) chez le donneur. La dose d'anticoagulant etait consideree comme elevee si elle etait de 300 unites/kg ou plus. Resultats : Des donnees sur l'administration d'anticoagulants aux donneurs etaient disponibles pour les receveurs des organes suivants : rein (301), foie (75) et poumon (46). L'heparine a ete administree dans 92 % des cas; son administration a ete refusee le plus souvent aux donneurs dont le deces etait d'origine cerebrovasculaire (p = 0,01). L'administration a ete tardive dans 59 % des cas et la dose etait faible dans 27 % des cas. Pour les receveurs de rein, l'administration d'heparine au donneur, le moment de l'administration et la dose d'heparine n'ont entraine aucune difference significative dans le besoin de dialyse et le debit de filtration glomerulaire durant la premiere annee apres la transplantation. Quant aux receveurs de foie, les concentrations de phosphatase alcaline etaient significativement plus elevees durant la premiere annee chez ceux dont le donneur avait recu des doses d'heparine plus faibles. Conclusion : L'heparine est couramment administree avant le deces dans les cas de DDC, mais la dose et le moment d'administration varient, des variations qui n'ont pas ete associees aux resultats renaux dans cette etude. L'administration d'anticoagulants chez le donneur pourrait avoir une plus grande incidence dans la prevention des complications biliaires a la suite d'une transplantation de foie.
The opportunity for organ donation is an important aspect of end-of-life care for some critically ill patients and their families. (1-3) Transplantation improves the survival of recipients, enhances their quality [...]