Outcomes From Brain Death Donors With Previous Cardiac Arrest Accepted for Pancreas Transplantation: A Single-center Retrospective Analysis.

OBJECTIVE: The aim of the study was to evaluate the effect of cardiac arrest time (CAT) in donors after brain death (DBD) donors on pancreas transplant outcome. SUMMARY OF BACKGROUND DATA: Results from donors after circulatory death report good outcomes despite warm ischemia times up to 57 minutes. Previous cardiac arrest in DBD has been addressed as a potential risk factor, but duration of the CAT has never been evaluated. METHODS: We conducted a retrospective analysis including 342 pancreas transplants performed at our center from 2000 to 2016, and evaluated the effect of previous cardiac arrest in DBD (caDBD) on pancreas transplant outcomes. RESULTS: A total of 49 (14.3%) caDBD were accepted for transplantation [median CAT of 5.0 min (IQR 2.5-15.0)]. Anoxic encephalopathy was most frequent and P-PASS higher (16.9 vs 15.6) in caDBD group when compared with other DBD. No differences were found in all other characteristics evaluated.Graft survival was similar between both groups, as was the incidence of early graft failure (EGF). CAT increased the risk for EGF [OR 1.09 (95% CI, 1.01-1.17)], and the duration of CPR discriminated for EGF [AUC of 0.86 (95% CI, 0.74-0.98)], with a sensitivity and specificity of 100% and 75% at a cutoff of 15 minutes. When evaluated separately, caDBD >15 min increased over 5 times the risk for EGF [HR 5.80 (95% CI, 1.82-18.56); P = 0.003], and these presented fewer days on the ICU (1.0 vs 3.0 d). CONCLUSION: CaDBD donors are suitable for routine pancreas transplantation without increasing EGF risk, and in those with longer CAT it may be prudent to postpone donation a few days to allow a thorough evaluation of organ damage following cardiac arrest.

Prevalence of cardiovascular risk factors in patients with type 1 diabetes in end-stage renal disease: changes in the trend from 1999 to 2006.

OBJECTIVE: The aim of this study was to describe the prevalence of cardiovascular disease risk factors (CVDRFs) and the degree of control in a Spanish population of patients with type 1 diabetes (DM1) and end-stage renal disease (ESRD) as well as the changes observed in this setting over 8 years. DESIGN AND METHODS: Patients with DM1 and ESRD were evaluated from 1999 to 2006. Clinical variables, smoking habit, glycosylated hemoglobin (HbA(1c)) and lipids values, and drug treatment were evaluated. The cohort was divided into four biannual groups for analysis. HbA(1c) >7, LDL >100 mg/dl, blood pressure (BP) >140/90 mmHg, and tobacco use were considered as CVDRFs. RESULTS: A total of 177 patients (65% male) with a mean age of 37.2+/-6.2 years were studied. They had 24.3+/-5.9 years of diabetes evolution. Mean HbA(1c) was 7.9+/-1.5% with 29.6% of patients having values less than 7%. Mean LDL was 109.3+/-40.4 mg/dl and 41.1% were below 100 mg/dl. Over the years these proportions increased significantly (P=.028 and .0015, respectively). Mean systolic and diastolic BP were 142.5+/-22.9 and 82.2+/-14.9 mmHg, respectively, with 53.8% of patients having BP <140/90 mmHg with no changes over the years (P=.11). The proportion of never smokers was 51.5%, reaching 65.5% in the last biannual period (P=.01). In the whole cohort, 89.3% had one or more CVDRFs. There was a statistically significant trend to a reduction in the number of CVDRFs over time (r=-.208, P=.005). CONCLUSIONS: CVDRFs are highly prevalent in patients with DM1 and ESRD. The control of these CVDRFs is still insufficient; however, there has been a clear improvement in the control over the years.