TY - JOUR
T1 - Antemortem heparin in organ donation after circulatory death determination
T2 - A systematic review of the literature
AU - Honarmand, Kimia
AU - Alshamsi, Fayez
AU - Foroutan, Farid
AU - Rochwerg, Bram
AU - Belley-Cote, Emilie
AU - McLure, Graham
AU - D’Aragon, Frederick
AU - Ball, Ian M.
AU - Sener, Alp
AU - Selzner, Markus
AU - Guyatt, Gordon
AU - Meade, Maureen O.
N1 - Funding Information:
E.B.-C. reports grants from Bayer and Roche, outside the submitted work. I.M.B. received a stipend for administrative work, Trillium Gift of Life ODO 2014-2019, Motivational Speaker for Gaia Insight. M.O.M. receives salary from the Trillium Gift of Life Network of Ontario for her work as a hospital donation physician. The other authors declare no conflicts of interest.
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Donation after circulatory death determination frequently involves antemortem heparin administration to mitigate peri-arrest microvascular thrombosis. We systematically reviewed the literature to: (1) describe heparin administration practices and (2) explore the effects on transplant outcomes. We searched MEDLINE and EMBASE for studies reporting donation after circulatory death determination heparin practices including use, dosage, and timing (objective 1). To explore associations between antemortem heparin and transplant outcomes (objective 2), we (1) summarized within-study comparisons and (2) used meta-regression analyses to examine associations between proportions of donors that received heparin and transplant outcomes. We assessed risk of bias using the Newcastle Ottawa Scale and applied the GRADE methodology to determine certainty in the evidence. For objective 1, among 55 eligible studies, 48 reported heparin administration to at least some donors (range: 15.8%–100%) at variable doses (up to 1000 units/kg) and times relative to withdrawal of life-sustaining therapy. For objective 2, 7 studies that directly compared liver transplants with and without antemortem heparin reported lower rates of primary nonfunction, hepatic artery thrombosis, graft failure at 5 y, or recipient mortality (low certainty of evidence). In contrast, meta-regression analysis of 32 liver transplant studies detected no associations between the proportion of donors that received heparin and rates of early allograft dysfunction, primary nonfunction, hepatic artery thrombosis, biliary ischemia, graft failure, retransplantation, or patient survival (very low certainty of evidence). In conclusion, antemortem heparin practices vary substantially with an uncertain effect on transplant outcomes. Given the controversies surrounding antemortem heparin, clinical trials may be warranted.
AB - Donation after circulatory death determination frequently involves antemortem heparin administration to mitigate peri-arrest microvascular thrombosis. We systematically reviewed the literature to: (1) describe heparin administration practices and (2) explore the effects on transplant outcomes. We searched MEDLINE and EMBASE for studies reporting donation after circulatory death determination heparin practices including use, dosage, and timing (objective 1). To explore associations between antemortem heparin and transplant outcomes (objective 2), we (1) summarized within-study comparisons and (2) used meta-regression analyses to examine associations between proportions of donors that received heparin and transplant outcomes. We assessed risk of bias using the Newcastle Ottawa Scale and applied the GRADE methodology to determine certainty in the evidence. For objective 1, among 55 eligible studies, 48 reported heparin administration to at least some donors (range: 15.8%–100%) at variable doses (up to 1000 units/kg) and times relative to withdrawal of life-sustaining therapy. For objective 2, 7 studies that directly compared liver transplants with and without antemortem heparin reported lower rates of primary nonfunction, hepatic artery thrombosis, graft failure at 5 y, or recipient mortality (low certainty of evidence). In contrast, meta-regression analysis of 32 liver transplant studies detected no associations between the proportion of donors that received heparin and rates of early allograft dysfunction, primary nonfunction, hepatic artery thrombosis, biliary ischemia, graft failure, retransplantation, or patient survival (very low certainty of evidence). In conclusion, antemortem heparin practices vary substantially with an uncertain effect on transplant outcomes. Given the controversies surrounding antemortem heparin, clinical trials may be warranted.
UR - http://www.scopus.com/inward/record.url?scp=85120674394&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85120674394&partnerID=8YFLogxK
U2 - 10.1097/TP.0000000000003793
DO - 10.1097/TP.0000000000003793
M3 - Review article
C2 - 33901108
AN - SCOPUS:85120674394
SN - 0041-1337
VL - 105
SP - E337-E346
JO - Transplantation
JF - Transplantation
IS - 12
ER -