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N Engl J Med. 2015 Jul 30;373(5):405-14. doi: 10.1056/NEJMoa1501969.

Therapeutic Hypothermia in Deceased Organ Donors and Kidney-Graft Function.

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From the Department of Anesthesia and Perioperative Care (C.U.N., J.F.) and the Department of Surgery, Division of Transplant Surgery (C.U.N., R.H., J.P.R.), University of California, San Francisco, San Francisco, the California Transplant Donor Network, Oakland (S.S.), and OneLegacy, Los Angeles (S.B., M.F.) - all in California; the Section of Surgical Critical Care, Veterans Affairs Portland Health Care System (M.C., D.M.), and the Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health and Science University (D.M.) - both in Portland; and Berry Consultants, Austin, TX (K.B.).



Delayed graft function, which is reported in up to 50% of kidney-transplant recipients, is associated with increased costs and diminished long-term graft function. The effect that targeted mild hypothermia in organ donors before organ recovery has on the rate of delayed graft function is unclear.


We enrolled organ donors (after declaration of death according to neurologic criteria) from two large donation service areas and randomly assigned them to one of two targeted temperature ranges: 34 to 35°C (hypothermia) or 36.5 to 37.5°C (normothermia). Temperature protocols, which were initiated after authorization was obtained for the organ to be donated and for the donor's participation in the study, ended when organ donors left the intensive care unit for organ recovery in the operating room. The primary outcome was delayed graft function in the kidney recipients, which was defined as the requirement for dialysis during the first week after transplantation. Secondary outcomes were the rates of individual organs transplanted in each treatment group and the total number of organs transplanted from each donor.


The study was terminated early, on the recommendation of an independent data and safety monitoring board, after the interim analysis showed efficacy of hypothermia. At trial termination, 370 organ donors had been enrolled (180 in the hypothermia group and 190 in the normothermia group). A total of 572 patients received a kidney transplant (285 kidneys from donors in the hypothermia group and 287 kidneys from donors in the normothermia group). Delayed graft function developed in 79 recipients of kidneys from donors in the hypothermia group (28%) and in 112 recipients of kidneys from donors in the normothermia group (39%) (odds ratio, 0.62; 95% confidence interval, 0.43 to 0.92; P=0.02).


Mild hypothermia, as compared with normothermia, in organ donors after declaration of death according to neurologic criteria significantly reduced the rate of delayed graft function among recipients. (Funded by the Health Resources and Services Administration; number, NCT01680744.).

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