1. Therapeutic Hypothermia in Deceased Organ Donors and Kidney-Graft Function R3 김동연 /Prof. 정경환 N Engl J Med 373;5 July 30, 2015

2. Introduction Delayed graft function ▫requirement for dialysis in the recipient within 7 days after renal transplantation ▫results in increased health care expenditures and decreased long-term graft function ▫reported in up to 50% of renal allografts recovered from donors after declaration of death according to neurologic criteria (brain-dead donors) Retrospective study involving patients with cardiac arrest, mild hypothermia appeared to protect against renal injury ▫reduced metabolism and reduction of free-radical production

3. Current protocols stipulate that normothermia, which frequently requires active warming, be maintained in organ donors Prospective, randomized, controlled trial Test the potential benefit and safety of targeted hypothermia in donors with respect to rates of delayed graft function among the recipients of their kidneys

4. Methods March 20, 2012, and October 17, 2013 Randomly assigned 394 donors who were identified by two organ-procurement organizations in their respective donation service areas Computer-generated block randomization to mild hypothermia (34 to 35°C) or normothermia (36.5 to 37.5°C) Randomization was stratified according to ▫organ-procurement organization ▫donor status (standard criteria or expanded criteria) ▫Whether or not the donor had received hypothermic treatment before declaration of death

5. therapeutic hypothermia ▫Spontaneously reach a body temperature of 34 to 35°C ▫cooled with the use of forced-air systems ▫passive-cooling devices normothermia group were kept warm (at a temperature of 36.5 to 37.5°C)

6. primary outcome ▫delayed graft function Secondary outcome ▫Adverse events ▫Rate of individual organs transplanted in each treatment group ▫number of organs transplanted from each enrolled donor

7. Results

12. conclusion Mild hypothermia, as compared with normothermia, in organ donors significantly reduced the rate of delayed graft function among recipients particularly evident in kidney recipients from the highest-risk donors