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The effect of inhalational anaesthesia during deceased donor organ procurement on post-transplantation graft survival

Departments of Critical Care and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Institute for Transformative Molecular Medicine, Departments of Anesthesiology & Perioperative Medicine, and Pulmonary and Critical Care, University Hospitals-Cleveland Medical Center, Department of Anesthesiology, MetroHealth Medical Center, Department of Pediatric Critical Care, Cleveland Clinic, Lifebanc, Cleveland, Children’s Hospital, Department of Critical Care, Akron Children’s Hospital. Akron, Ohio, USA


Many deceased by neurologic criteria donors are administered inhalational agents during organ recovery surgery—a process that is characterised by warm and cold ischaemia followed by warm reperfusion. In certain settings, volatile anaesthetics (VA) are known to precondition organs to protect them from subsequent ischaemia–reperfusion injury. As such, we hypothesised that exposure to VA during organ procurement would improve post-graft survival. Lifebanc (organ procurement organisation [OPO] for NE Ohio) provided the investigators with a list of death by neurologic criteria organ donors cared for at three large tertiary hospitals in Cleveland between 2006 and 2016—details about the surgical recovery phase were extracted from the organ donors’ medical records. De-identified data on graft survival were obtained from the United Network for Organ Sharing (UNOS). The collated data underwent comparative analysis based on whether or not VA were administered during procurement surgery. Records from 213 donors were obtained for analysis with 138 exposed and 75 not exposed. Demographics, medical histories, and organ procurement rates were similar between the two cohorts. For the primary endpoint, there were no significant differences observed in either early (30-day) or late (five-year) graft survival rates for kidney, liver, lung, or heart transplants. Our findings from this retrospective review of a relatively small cohort do not support the hypothesis that the use of VA during the surgical procurement phase improves graft survival. Reviews of larger datasets and/or a prospective study may be required to provide a definitive answer.

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