Cold Ischemia Time: An Independent Predictor of Increased Hla Class I Antibody Production After Rejection of a Primary Cadaveric Renal Allograft1

Abstract

Longer CIT induces a humorally more immunogenic kidney.

Clinical Relevance of Anti-HLA Antibodies Detected by Flow-Cytometry Bead-Based Assays—Single-Center Experience

“…In most cases (81.25%), anti-HLA antibodies were observed within the first 2 weeks posttransplantation and correlated with delayed graft function, immunologic complications, and reduced graft survival. Preformed HLAreactive antibodies have been found to be associated with DGF [24]. A possible explanation of our findings in which a correlation was observed between DGF and posttransplantation alloantibody development is that reperfusion and prolonged cold ischemia time (a chief factor leading to DGF) induce activation of endothelium, impaired cytokine gene expression [25,26], release of proinflammatory cytokines [27,28], and upregulation of HLA and adhesion molecules [29,30,31].…”

Effect of Delayed Graft Function in Hypersensitized Kidney Transplant Recipients

“…One of the most important factors associated to increased risk of DGF is a long cold ischemia time [6,13]. At the same time, it has been described that longer cold ischemia time induces a more immunogenic kidney, with higher production of HLA class I antibodies and higher risk of AR, independent of the existence of HLA mismatches [22]. Thus, preservation management may cause ischemia-reperfusion injury with accumulation of leukocytes and endothelial activation that finally result in elevation of cytokines that induce T-and B-cell activation that may lead to cell-and/or antibody-mediated rejection and poor graft survival [23].…”

Living-donor kidney transplantation: the Freiburg experience

“…This is reflected by superior function rates as compared to cadaveric kidney transplantation. Recent studies even support the theory that prolonged cold ischemia times enhance the immunogenicity of kidney grafts, therefore increasing the risk of acute rejection episodes (ARE) [4,5]. Furthermore, there is compelling evidence that pretransplant duration of dialysis is an independent risk factor for a decreased graft survival [6,7].…”