Older age, female sex, and increased IL-6 decrease the organ yield from cadaveric donors

Introduction

A variety of factors are believed to impact the number of organs explanted for transplantation in cadaveric organ donors, including age, stability of the patient and existing co-morbidities. Brain-death-induced systemic inflammation could also adversely affect the number of organs explanted for transplantation. Hence, in this observational study we sought to examine the various factors including the inflammatory response that occur in cadaveric organ donors and to determine their relative impact on organ explantation.

Methods

We enrolled 30 cadaveric organ donors in this prospective observational, two-center study. After obtaining informed consent, we collected clinical information including demographics, cause of death and donor management details. We measured plasma IL-6 levels at baseline and hourly for the first 4 hours after brain death and immediately before organ explantation. We analyzed the association between the number of organs explanted and clinical, demographic and immunologic variables by univariate and multivariable regression. Finally, we repeated our analysis on donors younger than 50 years of age.

Results

The number of organs explanted from patients ranged from 0 to 7, with an average of about three organs per patient. In multivariable analysis, older age and female sex were the only variables significantly associated with less than three organs explanted (age: OR = 0.89, 95% CI 0.81–0.96, P = 0.003; female sex: OR = 0.13, 95% CI 0.02–0.76, P = 0.024). In subgroup analysis, we found that in donors aged younger than 50 years (n = 17), female sex still had a significant negative impact on organs explanted (P = 0.0002), but age was no longer significant. However, in the younger than 50 age group the mean plasma IL-6 concentration was also negatively associated with the number of organs explanted (P = 0.001).

Conclusion

Age, as expected, appears to be the primary factor impacting the number of organs explanted from cadaveric organ donors. Surprisingly, female sex is associated with a decreased number of organs explanted. In donors younger than 50 years of age, female sex and mean plasma IL-6 concentrations significantly impacted the number of organs explanted.