Deleterious Influence of Prolonged Warm Ischemia in Living Donor Kidney Transplantation

Hellegering, Joyce; Visser, Jelle; Kloke, H. J.; d’Ancona, Frank; Hoitsma, Andries J.; Vliet, J. Adam van der; Warlé, Michiel C.

doi:10.1016/j.transproceed.2012.01.118

Cited by 61 publications

(66 citation statements)

References 18 publications

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“…Every five min of longer anastomosis time was associated with one extra day in hospital due to delayed graft function15. A deleterious influence of prolonged warm ischemia on long-term graft survival was also observed after living donor transplantation6. Most of the studies indicated that WIT longer than 30 min should be considered as a major, potentially modifiable risk factor for inferior long-term results after kidney transplantation.…”

Section: Discussionmentioning

confidence: 99%

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The influence of warm ischemia elimination on kidney injury during transplantation – clinical and molecular study

Kamińska

Kościelska‐Kasprzak

Chudoba

et al. 2016

Sci Rep

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Kidney surface cooling was used during implantation to assess the effect of warm ischemia elimination on allograft function, histological changes and immune-related gene expression. 23 recipients were randomly assigned to a group operated on with kidney surface cooling during implantation (ice bag technique, IBT group), and the other 23 recipients receiving the contralateral kidney from the same donor were operated on with a standard technique. Three consecutive kidney core biopsies were obtained during the transplantation procedure: after organ recovery, after cold ischemia and after reperfusion. Gene expression levels were determined using low-density arrays (Format 32, TaqMan). The IBT group showed a significantly lower rate of detrimental events (delayed graft function and/or acute rejection, p = 0.015) as well as higher glomerular filtration rate on day 14 (p = 0.026). A greater decrease of MMP9 and LCN2 gene expression was seen in the IBT group during total ischemia (p = 0.003 and p = 0.018). Elimination of second warm ischemia reduced the number of detrimental events after kidney transplantation, and thus had influence on the short-term but not long-term allograft function. Surface cooling of the kidney during vascular anastomosis may reduce some detrimental effects of immune activation resulting from both brain death and ischemia-reperfusion injury.

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Section: Discussionmentioning

confidence: 99%

“…Prolongation of WIT is not only detrimental for immediate renal allograft function but also influences long-term results34. Prolonged WIT was also associated with longer hospitalization after kidney transplantation5 and impaired long-term graft survival after living donation6 as well as deceased donor7 kidney transplantation.…”

mentioning

confidence: 99%

The influence of warm ischemia elimination on kidney injury during transplantation – clinical and molecular study

Kamińska

Kościelska‐Kasprzak

Chudoba

et al. 2016

Sci Rep

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“…Furthermore, laparoscopic procurement, overweight recipient, right donor kidney, and multiple renal arteries are shown to be significantly associated with prolonged warm ischemic time by multivariate analysis. 52 In a study that included 469 patients, Brennan and associates 48 reported that the mean warm ischemia time was higher in patients with slow graft function or DGF versus patients with early graft function.…”

Section: Ischemia Timementioning

confidence: 99%

“…Table 2 summarizes the studies reporting the risk factors associated with the incidence of DGF in living-donor kidney transplants. 11,17,31,32,33,38,41,44,46,48,52,54,58,64,65 Treating risks associated with DGF Given the paucity of data about the effects of and the risk factors for DGF in living-donor kidney transplant, studies that focus on treating these risk factors are also limited. However, given the effects of DGF after living-donor kidney transplant, strategies to minimize or prevent the risk of DGF are needed.…”

Section: Other Risk Factorsmentioning

confidence: 99%

Untitled

2016

Exp Clin Transplant

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With an increased incidence of living-donor kidney transplants, in response to increasing unmet needs for renal transplant, a clear understanding of determinants of posttransplant outcomes is essential. The importance of delayed graft function in deceased-donor kidney transplant is now part of conventional medical wisdom, due to the large amount of evidence focused on this aspect. However, the same is not true for living-donor kidney transplant, partly due to lack of evidence on this crucial clinical question and partly due to lack of awareness about this issue. The current review aims to highlight the importance of delayed graft function as a crucial determinant of outcomes in living-donor kidney transplant. An exhaustive search of online medical databases was performed with appropriate search criteria to collect evidence about delayed graft function after living-donor kidney transplant, with a special focus on studies from the Middle East. Data on incidence, impact, risk factors, and possible prevention modalities of delayed graft function in patients undergoing living-donor kidney transplant are presented. A key finding of this review is that contemporary incidence rates reported from the Middle East are comparatively higher than those reported from outside the region. Although in absolute terms the incidence is lower than deceaseddonor kidney transplant, the effects of delayed graft function on graft rejection and graft and patient survival are sufficiently large to warrant the formulation of specific treatment protocols. Key to formulating prevention and treatment strategies is identifying discrete risk factors for delayed graft function. Although this evidence is scant, an overview has been provided. Further studies examining different aspects of delayed graft function incidence after living-donor kidney transplant are urgently needed to address a so far little known clinical question.

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“…Hellegering et al investigated the determinants of poor EGF and showed that prolonged (>45 minutes) total WIT (retrieval and anastomosis) was one of the predictors of poor EGF in either open or laparoscopic LDKT [15]. Brennan et al also examined the risk factors for poor EGF in LDKTs performed after either open or laparoscopic donor nephrectomy [10].…”

mentioning

confidence: 99%

Correlation of Surgical Times with Laparoscopic Live Donor Kidney Transplant Outcomes

Çimen¹,

Güler²,

Alwayn³

et al. 2013

OJOTS

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Most studies revealed that ischemic time has substantial role in occurrence of delayed graft function (DGF) after deceased donor kidney transplantation. However, less is known about the potential impact of surgical times on early outcomes following live donor kidney transplantation. A retrospective cohort of 189 consecutive laparoscopic live donor kidney transplant (LDKT) recipients from January 2006 to August 2012 was analyzed to reveal the impact of pneumoperitoneum time (PT) and anastomosis time (AT) on donor and recipient length of hospital stay and early graft function (EGF). DGF was observed in 13 (6.8%) patients while slow graft function (SGF) was seen in 27 (14%) of the recipients. The median AT was 28 minutes (interquartile range 23, 35 minutes). AT was associated with DGF (Odds Ratio [OR] 1.044, per minute, 95% CI 1.007, 1.082, p = 0.018). Median recipient length of hospital stay was 8 (interquartile range 7, 11) days. Every 13.5 minutes of longer AT was associated with 1 extra day in hospital. The median PT was 180 minutes (interquartile range 144, 234 minutes). PT was associated with both DGF (OR 1.013 per minute, 95% CI 1.005, 1.021, p = 0.001) and SGF (OR 1.009 per minute, 95% CI 1.002, 1.016, p = 0.016). Every extra hour of PT was associated with 0.42 more days in hospital for the donor. Surgical times may be underestimated variables in dictating use of hospital resources. The effect of surgical times on long term hard outcomes entails further study.

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Deleterious Influence of Prolonged Warm Ischemia in Living Donor Kidney Transplantation

Cited by 61 publications

References 18 publications

The influence of warm ischemia elimination on kidney injury during transplantation – clinical and molecular study

The influence of warm ischemia elimination on kidney injury during transplantation – clinical and molecular study

Untitled

Correlation of Surgical Times with Laparoscopic Live Donor Kidney Transplant Outcomes

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