Keep cool and carry on…

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Delayed graft function (DGF) after kidney transplant is
associated with long-term allograft dysfunction. Niemann et al. (NEJM
2015;373:405) reported
that therapeutic hypothermia reduced DGF (defined here as the requirement of
dialysis in the recipient within 7 days after renal transplantation).
Study group enrolled 370 kidney donors after neurological
determination of death (DNDDs), randomized to either normothermia (36.5 to 37.5
deg., n= 280) vs. mild hypothermia (34-35
deg
. either by allowing to spontaneously reach the temperature, or by
passive-cooling devices or forced-air systems, n=286). Incidence of DGF was
significantly lower in hypothermia group (28.2% vs 39.2%, p=0.008), and study
was terminated early.  
Therapeutic hypothermia (targeted temperature management) is
an established intervention for outside-hospital cardiac
arrest
to protect neurological function.
In transplant field, in contrast, current organ procurement
protocol (e.g. one
from NATCO
) has a stipulation that normal body temperature should be
maintained in donors, frequently requiring active warming with warm blankets.
 What is the protective mechanism?  Authors discussed possible contribution of
ischemia-reperfusion injury. Is this procedure applicable to other organs? Many
questions arise and there is a nice
open forum with NEJM group
to discuss these (til August 7th
EDT).
Naoka Murakami, MD PhD

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