Influence of donor criteria on early outcome after intestinal transplantation.

From May 1990 to September 1995. a total of 72 patients received 77 intestinal grafts (27 isolated intestine, 36 liver and intestinal, and 14 multivisceral) at our center. Donors ranged from newborn to age 48 years. Fifty-one donors were male, and 26 were female. The most common causes of death were motor-vehicle accidents, cerebrovascular accidents. and gunshot wounds. Length of hospital stay for the donors was 1 to 21 days. Ten of 77 donors had cardiopulmonary resuscitation, and 18 were maintained on high vasopressor (either higher than 10 J.Lg/kg per minute of dopamine, norepinephrine and/or epinephrine) during the donor operation. A total of 2 to 4 L (50 to 100 mL/kg in children) of University of Wisconsin (UW) solution was used for in situ perfusion in the donor operation. Cold ischemia time (CIT) ranged from 2.8 to 17 hours, with a mean of 7.7 hours. Donor and recipient procedures are described elsewhere.2 Postoperative immunosuppression was with tacrolimus (FK 506), steroids, and in selected cases azathioprine (AZA). In an effort to predict the quality of early posttransplant graft function, donor variables such as age, sex, hospital stay, CPR. vasopressor. oxygenation (ratio of Po2/Fio2 ). sodium. creatinine. total bilirubin, AST, AL T, and CIT were studied. The donor variables were analyzed in regard to 3-month actual graft survival and grading of tissue damage of postperfusion intestinal specimens (2 to 4 hours after reperfusion) as well as posttransplant intestinal biopsy (within 7 days after transplantation). The grading of histology was by Park classification on a scale of I to 8.' Multivariate stepwise (backward elimination method) logistic regression for survival and linear regression for intestinal histology were used for statistical analysis.