The impact of neurologically deceased donors' blood pressures on clinical outcomes in transplant recipients: a systematic review.Basmaji, J., et al.
Canadian Journal of Anaesthesia 2020 [record in progress].
This study aimed to determine the optimal blood pressure (BP) target in neurologically deceased organ donors in order to improve organ transplant outcomes.
Searches were performed on EMBASE and MEDLINE up to the end of December 2018. Study selection and data extraction were conducted by two reviewers. The risk of bias was assessed using the Risk of Bias in Non-Randomized Studies of Intervention (ROBINS-I) tool.
12 studies were included in the review.
The main outcomes of interest included the assessment of the effect of donor BP on graft function, graft survival and the number of organs transplanted per donor.
This narrative systematic review evaluated the evidence regarding the effect of blood pressure targets in neurologically deceased donors on clinical outcomes in transplant recipients. Medline and Embase were searched with the help of an information specialist up to 2018. Two independent reviewers selected articles for inclusion and performed data extraction. The quality of studies was assessed using the ROBINS-I tool and the quality and strength of the evidence was assessing using the GRADE system. Twelve cohort studies met de inclusion criteria of which most reported on the kidney (10 studies) followed by the liver (2 studies) and pancreas (islet isolation, 1 study). The number of donors included in the studies ranged from 24 to 380. The ROBINS-I tool scored studies as having moderate (50%) or serious (50%) risks of bias and GRADE scores for the quality of the evidence for graft function and graft survival were both ‘very low’. Seven studies showed that hypotension was associated with worse graft function and graft survival whilst three studies showed no relationship between blood pressure and clinical outcomes. The authors are cautious with drawing firm conclusions considering the low quality of the evidence.