Determining optimal threshold for glucose control in organ donors after neurologic determination of death: A United Network for Organ Sharing Region 5 Donor Management Goals Workgroup prospective analysis

Mitchell B. Sally, Tyler Ewing, Megan Crutchfield, Madhukar S. Patel, Shariq Raza, Salvador De La Cruz, John Zatarain, Darren Jay Malinoski

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

BACKGROUND: The appropriate level of glucose control in organ donors after neurologic determination of death (DNDD) remains uncertain. We hypothesized that a glucose target of 180 mg/dL would be appropriate for optimizing organ transplantation rates and outcomes. METHODS: Demographic, critical care, organ transplantation, and graft outcome datawere prospectively collected on all DNDDs in United Network for Organ Sharing (UNOS) Region 5 from 2010 to 2012. Glucose levelswere assessed at four time points in the organ donation process. The primary outcome measure was having four or more organs transplanted per donor (OTPD). Univariate analyses were conducted to determine the relationship between glucose levels and OTPD, organ transplantation rates, and graft function. Multivariate analyses were performed to determine independent predictors of four or more OTPDs. Glucose levels were analyzed at the following cutoff points: 150 or less, 180, and 200 mg/dL. Results with a p > 0.05 are listed. RESULTS: A total of 1,611 DNDDs had a mean (SD) age of 38 (17) years and 3.4 (1.7) OTPDs. Forty-one percent had four or more OTPDs. Glucose levels of 150 mg/dL or less were not associated with differences in organ use. Levels of 180 mg/dL or less were associated with more OTPDs (3.5 vs. 3.2), a higher rate of four or more OTPDs (42% vs. 34%), and more heart (34% vs. 28%), pancreas (18% vs. 11%), and kidney (85% vs. 81%) use. Levels of 200 mg/dL or less revealed similar results. However, only a level of 180 mg/dL or less was an independent predictor of four or more OTPDs (odds ratio, 1.4). All three levels were associated with higher kidney graft survival after a mean (SD) of 10 (6.0) months of follow-up (97% vs. 95%). CONCLUSION: Hyperglycemia is common in DNDDs and is associated with lower organ transplantation rates and worse graft outcomes. Targeting a glucose level of 180 mg/dL or less seems to preserve outcomes and is consistent with general critical care guidelines.

Original languageEnglish (US)
Pages (from-to)62-69
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Volume76
Issue number1
DOIs
StatePublished - Jan 2014
Externally publishedYes

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Nervous System
Tissue Donors
Glucose
Organ Transplantation
Critical Care
Transplants
Kidney
Tissue and Organ Procurement
Graft Survival
Hyperglycemia
Pancreas
Multivariate Analysis
Odds Ratio
Demography
Outcome Assessment (Health Care)
Guidelines

Keywords

  • Donor management goals; Hyperglycemia; Transplant graft outcomes

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Determining optimal threshold for glucose control in organ donors after neurologic determination of death : A United Network for Organ Sharing Region 5 Donor Management Goals Workgroup prospective analysis. / Sally, Mitchell B.; Ewing, Tyler; Crutchfield, Megan; Patel, Madhukar S.; Raza, Shariq; De La Cruz, Salvador; Zatarain, John; Malinoski, Darren Jay.

In: Journal of Trauma and Acute Care Surgery, Vol. 76, No. 1, 01.2014, p. 62-69.

Research output: Contribution to journalArticle

Sally, Mitchell B. ; Ewing, Tyler ; Crutchfield, Megan ; Patel, Madhukar S. ; Raza, Shariq ; De La Cruz, Salvador ; Zatarain, John ; Malinoski, Darren Jay. / Determining optimal threshold for glucose control in organ donors after neurologic determination of death : A United Network for Organ Sharing Region 5 Donor Management Goals Workgroup prospective analysis. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 76, No. 1. pp. 62-69.
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abstract = "BACKGROUND: The appropriate level of glucose control in organ donors after neurologic determination of death (DNDD) remains uncertain. We hypothesized that a glucose target of 180 mg/dL would be appropriate for optimizing organ transplantation rates and outcomes. METHODS: Demographic, critical care, organ transplantation, and graft outcome datawere prospectively collected on all DNDDs in United Network for Organ Sharing (UNOS) Region 5 from 2010 to 2012. Glucose levelswere assessed at four time points in the organ donation process. The primary outcome measure was having four or more organs transplanted per donor (OTPD). Univariate analyses were conducted to determine the relationship between glucose levels and OTPD, organ transplantation rates, and graft function. Multivariate analyses were performed to determine independent predictors of four or more OTPDs. Glucose levels were analyzed at the following cutoff points: 150 or less, 180, and 200 mg/dL. Results with a p > 0.05 are listed. RESULTS: A total of 1,611 DNDDs had a mean (SD) age of 38 (17) years and 3.4 (1.7) OTPDs. Forty-one percent had four or more OTPDs. Glucose levels of 150 mg/dL or less were not associated with differences in organ use. Levels of 180 mg/dL or less were associated with more OTPDs (3.5 vs. 3.2), a higher rate of four or more OTPDs (42{\%} vs. 34{\%}), and more heart (34{\%} vs. 28{\%}), pancreas (18{\%} vs. 11{\%}), and kidney (85{\%} vs. 81{\%}) use. Levels of 200 mg/dL or less revealed similar results. However, only a level of 180 mg/dL or less was an independent predictor of four or more OTPDs (odds ratio, 1.4). All three levels were associated with higher kidney graft survival after a mean (SD) of 10 (6.0) months of follow-up (97{\%} vs. 95{\%}). CONCLUSION: Hyperglycemia is common in DNDDs and is associated with lower organ transplantation rates and worse graft outcomes. Targeting a glucose level of 180 mg/dL or less seems to preserve outcomes and is consistent with general critical care guidelines.",
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T1 - Determining optimal threshold for glucose control in organ donors after neurologic determination of death

T2 - A United Network for Organ Sharing Region 5 Donor Management Goals Workgroup prospective analysis

AU - Sally, Mitchell B.

AU - Ewing, Tyler

AU - Crutchfield, Megan

AU - Patel, Madhukar S.

AU - Raza, Shariq

AU - De La Cruz, Salvador

AU - Zatarain, John

AU - Malinoski, Darren Jay

PY - 2014/1

Y1 - 2014/1

N2 - BACKGROUND: The appropriate level of glucose control in organ donors after neurologic determination of death (DNDD) remains uncertain. We hypothesized that a glucose target of 180 mg/dL would be appropriate for optimizing organ transplantation rates and outcomes. METHODS: Demographic, critical care, organ transplantation, and graft outcome datawere prospectively collected on all DNDDs in United Network for Organ Sharing (UNOS) Region 5 from 2010 to 2012. Glucose levelswere assessed at four time points in the organ donation process. The primary outcome measure was having four or more organs transplanted per donor (OTPD). Univariate analyses were conducted to determine the relationship between glucose levels and OTPD, organ transplantation rates, and graft function. Multivariate analyses were performed to determine independent predictors of four or more OTPDs. Glucose levels were analyzed at the following cutoff points: 150 or less, 180, and 200 mg/dL. Results with a p > 0.05 are listed. RESULTS: A total of 1,611 DNDDs had a mean (SD) age of 38 (17) years and 3.4 (1.7) OTPDs. Forty-one percent had four or more OTPDs. Glucose levels of 150 mg/dL or less were not associated with differences in organ use. Levels of 180 mg/dL or less were associated with more OTPDs (3.5 vs. 3.2), a higher rate of four or more OTPDs (42% vs. 34%), and more heart (34% vs. 28%), pancreas (18% vs. 11%), and kidney (85% vs. 81%) use. Levels of 200 mg/dL or less revealed similar results. However, only a level of 180 mg/dL or less was an independent predictor of four or more OTPDs (odds ratio, 1.4). All three levels were associated with higher kidney graft survival after a mean (SD) of 10 (6.0) months of follow-up (97% vs. 95%). CONCLUSION: Hyperglycemia is common in DNDDs and is associated with lower organ transplantation rates and worse graft outcomes. Targeting a glucose level of 180 mg/dL or less seems to preserve outcomes and is consistent with general critical care guidelines.

AB - BACKGROUND: The appropriate level of glucose control in organ donors after neurologic determination of death (DNDD) remains uncertain. We hypothesized that a glucose target of 180 mg/dL would be appropriate for optimizing organ transplantation rates and outcomes. METHODS: Demographic, critical care, organ transplantation, and graft outcome datawere prospectively collected on all DNDDs in United Network for Organ Sharing (UNOS) Region 5 from 2010 to 2012. Glucose levelswere assessed at four time points in the organ donation process. The primary outcome measure was having four or more organs transplanted per donor (OTPD). Univariate analyses were conducted to determine the relationship between glucose levels and OTPD, organ transplantation rates, and graft function. Multivariate analyses were performed to determine independent predictors of four or more OTPDs. Glucose levels were analyzed at the following cutoff points: 150 or less, 180, and 200 mg/dL. Results with a p > 0.05 are listed. RESULTS: A total of 1,611 DNDDs had a mean (SD) age of 38 (17) years and 3.4 (1.7) OTPDs. Forty-one percent had four or more OTPDs. Glucose levels of 150 mg/dL or less were not associated with differences in organ use. Levels of 180 mg/dL or less were associated with more OTPDs (3.5 vs. 3.2), a higher rate of four or more OTPDs (42% vs. 34%), and more heart (34% vs. 28%), pancreas (18% vs. 11%), and kidney (85% vs. 81%) use. Levels of 200 mg/dL or less revealed similar results. However, only a level of 180 mg/dL or less was an independent predictor of four or more OTPDs (odds ratio, 1.4). All three levels were associated with higher kidney graft survival after a mean (SD) of 10 (6.0) months of follow-up (97% vs. 95%). CONCLUSION: Hyperglycemia is common in DNDDs and is associated with lower organ transplantation rates and worse graft outcomes. Targeting a glucose level of 180 mg/dL or less seems to preserve outcomes and is consistent with general critical care guidelines.

KW - Donor management goals; Hyperglycemia; Transplant graft outcomes

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