Donor Hypothermia Reduces Delayed Graft Function

In deceased organ donors, inducing a period of mild hypothermia reduces the rate of delayed kidney function after transplantation, concludes a trial in the New England Journal of Medicine.

After declaration of death according to neurologic criteria, deceased organ donors in two donation service areas were assigned to hypothermia, 34° to 35° C; or normothermia, 36.5° to 37.5° C. The temperature protocols began as soon as donation was authorized and continued until the patient left the intensive care unit for organ recovery. The main outcome of interest was the rate of delayed graft function, defined as need for dialysis in the first week after kidney transplant.

The study was terminated early when interim analysis showed the “overwhelming efficacy” of hypothermia. At that time, 370 deceased donors had been enrolled and 572 patients had received a kidney transplant.

Delayed graft function occurred in 28 percent of patients receiving kidneys from donors assigned to hypothermia versus 39 percent for recipients of kidneys from the normothermia group. On multivariable analysis, the odds ratio for delayed graft function with organs from the normothermia group was 0.62. The benefit of hypothermia was greater in renal grafts from expanded-criteria donors and other high-risk subgroups.

Delayed graft function occurs in up to half of recipients of kidneys from deceased donors. This trial found that inducing mild therapeutic hypothermia in the donor after declaration of death reduces the risk of delayed function after kidney transplantation. The improvement in clinical outcomes may be most pronounced in recipients of kidneys from the highest-risk donors [Niemann CU, et al. Therapeutic hypothermia in deceased organ donors and kidney-graft function. N Engl J Med 2015; 373:405–414].