Impact of cold ischemia time on renal allograft outcome using kidneys from young donors

Abstract

Summary Prolonged cold ischemia time (CIT) is associated with delayed graft function and worse kidney transplant (KT) outcome, but the effect of CIT on long‐term allograft survival in KT from younger donors has not been well established. We investigated the predictive value of CIT exposure on long‐term death‐censored graft loss in 829 KT recipients from younger donors (<50 years) that were performed in our center between 1991 and 2005. Overall death‐censored graft failure rate was significantly higher in CIT≥19 h group versus CIT<19 h group (26 vs. 16.5%; P = 0.002). Significant differences were also observed when patients with primary nonfunctioning graft were excluded (21 vs. 14%; P = 0.020) and in patients who received tacrolimus plus mycophenolate mofetil (12 vs. 4%; P = 0.05). By multivariate Cox analysis, CIT was found to be independently associated with death‐censored graft loss with a 20% increase for every 5 h of CIT [relative risk (RR) 1.04; 95% Confidence Interval (CI): 1.01–1.1; P = 0.021]. Likewise, graft loss risk significantly increased in CIT≥19 h group versus CIT<19 h group (RR 1.5; 95%CI: 1.1–2.1; P = 0.023). Prolonged CIT is an independent predictor of graft survival in KT from younger donors. Efforts at minimizing CIT (<19 h) should improve transplant outcome significantly in this population.

Hypertension in standard criteria deceased donors is associated with inferior outcomes following kidney transplantation

“…Similar to our findings, among post‐transplant factors, the adverse impact of DGF and acute rejection on long‐term outcomes has also been described by numerous authors (15, 20, 25, 26). However, these factors are not available for decision making during a kidney offer.…”

Comparable transplant outcomes between local and shipped deceased‐donor kidneys in Australia: Analysis of Australia and New Zealand Dialysis and Transplant Registry 1992–2007

“…However, shipped allografts with no HLA mismatches had similar graft survival compare to locally‐transplanted allografts with no HLA mismatches. This finding is consistent with a single‐centre study demonstrating that extended cold ischaemic time was independently associated with increased graft loss in renal transplantation (cold ischaemic time ≥19 h compared to <19 h; relative risk 1.5, 95% CI 1.1–2.1, P = 0.023) 5 . In addition, longer duration of allograft ischaemia has been associated with increased risk of DGF and rejection but this association is inconsistent 6,7 .…”

Sulodexide alone or in combination with low doses of everolimus inhibits the hypoxia-mediated epithelial to mesenchymal transition in human renal proximal tubular cells

“…These results have been confirmed by additional studies [16,17]. In addition, inflammation, oxidative stress and the apoptotic machinery activated by reperfusion may exacerbate the renal hypoxic insult [18].…”