A Comparison of Long-Term Graft Survival Rates Between the First and Second Donor Kidney Transplanted-The Effect of a Longer Cold Ischaemic Time for the Second Kidney

Abstract

Prolonged cold ischaemic time (CIT) is associated with delayed initial graft function and may also have a negative impact on long-term graft outcome. We carried out a study comparing the long-term graft survival rates between those recipients who received the first of a pair of donor kidneys versus the recipient of the second graft.Adult kidney transplant recipients who received one of a pair of donor kidneys at our institution between 1989-1995 were included. All recipients received a cyclosporin based immunosupression regimen. Graft survival rates were compared between the 2 groups at 1-, 3-, 5-and 10-year intervals. A total of 520 renal transplant grafts were included in this study. Mean donor age was 35.4 years. Groups were similar for recipient age, gender, number of HLA mismatches, transplant number for that patient and percentage PRA. CIT was the only variable that was significantly different between the two groups; mean of 19.93 h in the first group compared to 25.65 h in the second group. Graft survival rates for the first kidney were significantly better than the second kidney-graft survival at 1 year 88.5% versus 84.7%, at 3 years 81.8% versus 76.7%, at 5 years 72.2% versus 64.9% and at 10 years 55.2% versus 40% (p = 0.012). Patient survival rates were similar in both groups.In our experience, the long-term graft survival rates are significantly better for the first kidney transplanted compared to the second kidney.

Trends in Kidney Transplantation in Australia and New Zealand, 1993–2004

“…Prolonged cold ischemia time is associated with higher risks for DGF and may adversely affect graft outcome (14,15). However, our analysis found that in deceased donor transplants, total ischemia time of Ͼ18 hr was not associated with worse graft survival at 1-5 years when compared to total ischemia time of Ͻ12 hr (data not shown).…”

Ten-year graft survival of deceased-donor kidney transplantation: a single-center experience

“…Univariate analysis shows that cold ischemic time is the independent factor that could correlate with long-term graft survival in our cohort, but using Cox regression model we found that this variable was not related to graft survival rate. Detrimental effect of increasing cold ischemia time on long-term graft survival has been proved in several other reports, for example, Giblin et al 28 compared the recipients of a first deceased donor transplanted and the recipient of the second donor kidney transplanted. The 5-and 10-year survival was 72 and 55% for the first kidney transplanted, respectively, compared with 65 and 40% for the second kidney transplanted.…”

Oral hydrogen water prevents chronic allograft nephropathy in rats

“…The vast majority of late failures are attributable to chronic allograft nephropathy (CAN), recently reclassified as interstitial fibrosis and tubular atrophy with unknown etiology. [3][4][5][6] The clinical course of CAN is characterized by a progressive deterioration in renal function, manifested by increasing renal hypertension and proteinuria. Presently, no specific treatment is available for chronic rejection in clinical transplantation despite a number of successful approaches in animal models, including the use of macrophage inhibitors, angiotensin converting enzyme inhibitors, and endothelin A receptor antagonists.…”