Effect of donor-disseminated intravascular coagulation in liver transplantation

Regulation of Coagulation Abnormalities and Temperature in Organ Donors

The 3 most common reasons for abnormal coagulation of blood in organ donors result from prior medications, consumption or dilution of coagulation factors and platelets during massive transfusion, and disseminated intravascular coagulation. Evaluation and treatment of these conditions are reviewed, and recommendations are provided for ordering appropriate laboratory tests and blood bank products.

Implications of donor disseminated intravascular coagulation on kidney allograft recipients

BACKGROUND AND OBJECTIVES

Disseminated intravascular coagulation (DIC) is common in deceased kidney donors and is considered a relative contraindication to donation. The significance of donor DIC on recipient kidney function is poorly understood. Additionally, the significance of thrombocytopenia in recipients of kidneys from DIC-positive donors is understudied.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

In a retrospective cohort of 162 kidney transplants, the presence of DIC in donors, the occurrence of thrombocytopenia in recipients, and risk factors for delayed or slow graft function (DGF/SGF) were assessed. The effects of DIC donor status on DGF/SGF in the study sample as a whole, and of thrombocytopenia on DGF/SGF in recipients of DIC-positive kidneys specifically, were examined using multiple logistic regression.

RESULTS

DIC donor status was not associated with occurrence of DGF/SGF, but thrombocytopenia was significantly associated with DIC-positive donor status (P=0.008). Thrombocytopenia was independently associated with DGF/SGF only in the recipients of DIC-positive kidneys (P=0.005). Patient and graft survival at 1 year were not affected by donor DIC status or by thrombocytopenia status.

CONCLUSIONS

Donor DIC was not associated with short-term suboptimal graft function, defined as DGF/SGF, nor with long-term patient or graft survival. However, thrombocytopenia appears to portend DGF/SGF in recipients of DIC-positive kidneys and may be a clinical sign on which the basis of therapeutic decisions could be undertaken.

Effect of posttraumatic donor's disseminated intravascular coagulation in intrathoracic organ donation and transplantation

INTRODUCTION

Our aim was to evaluate the influence on yield and function of intrathoracic organs from donors after severe cranial trauma complicated by disseminated intravascular coagulation (DIC).

MATERIALS AND METHODS

This retrospective observational study in a patient cohort with severe cranial trauma reading to brain death compared the number of harvested thoracic organs among individuals with versus without previous DIC. We examined exclusions for organ donation and their probable relationship to DIC. We also analyzed blood components transfused to normalize coagulation parameters. The organ recipients were followed for 1 month to detect acute graft failure.

RESULTS

Among 147 organ donors, 37 were brain dead after suffering severe cranial trauma and 13 met DIC criteria upon admission. We did not observe demographic differences among donors, although there was a trend for DIC donors to be younger (32 +/- 10 vs 40 +/- 21 years old; P = .11). Twenty-eight donors (12 with DIC and 16 without) and 29 donors (13 with DIC and 16 without) met age and medical criteria for potential heart or lung donation, respectively. Donation exclusion was related to trauma instead of DIC itself. We did not find any difference among the number of cardiac and lung organs harvested from organ donors with DIC (67% and 31%, respectively) or without DIC (75% and 44%, respectively). All DIC donors had clinical bleeding and received multiple units of blood products. Organs were harvested 37 +/- 23 (13 to 80) hours after admission. All patients had normalized coagulation parameters at surgery. In the postoperative evolution, none of the cardiac or lung recipients from DIC donors met primary graft failure criteria.

CONCLUSIONS

We concluded that hearts and lungs from donors with previous DIC were suitable for transplant recipients.

Regulation of coagulation abnormalities and temperature in organ donors

The 3 most common reasons for abnormal coagulation of blood in organ donors result from prior medications, consumption or dilution of coagulation factors and platelets during massive transfusion, and disseminated intravascular coagulation. Evaluation and treatment of these conditions are reviewed, and recommendations are provided for ordering appropriate laboratory tests and blood bank products.