Effect of Long Cold Ischemia Time of Kidneys from Aged Donors on Prognosis of Kidney Transplantation

Lian, Ling; Yang, Dengfeng; Li, Xia; Cheng, Ke; Huang, Jufang

doi:10.12659/aot.928735

Cited by 8 publications

(8 citation statements)

References 43 publications

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“…In fact, it has been reported that an additional hour of CIT may increase the risk of graft failure [ 8 ]. The deleterious effects of prolonged CIT are enhanced in recipients of kidneys from older donors [ 9 , 10 ]. The increasing acceptance of older and higher risk donor kidneys has reduced enthusiasm for simple cold storage, which was previously made possible by the development of better organ preservation solutions [ 11 ].…”

Section: Risk Factors For Dgfmentioning

confidence: 99%

Delayed Graft Function in Kidney Transplant: Risk Factors, Consequences and Prevention Strategies

Ponticelli¹,

Reggiani

Moroni

2022

JPM

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Background. Delayed graft function is a frequent complication of kidney transplantation that requires dialysis in the first week posttransplant. Materials and Methods. We searched for the most relevant articles in the National Institutes of Health library of medicine, as well as in transplantation, pharmacologic, and nephrological journals. Results. The main factors that may influence the development of delayed graft function (DGF) are ischemia–reperfusion injury, the source and the quality of the donated kidney, and the clinical management of the recipient. The pathophysiology of ischemia–reperfusion injury is complex and involves kidney hypoxia related to the duration of warm and cold ischemia, as well as the harmful effects of blood reperfusion on tubular epithelial cells and endothelial cells. Ischemia–reperfusion injury is more frequent and severe in kidneys from deceased donors than in those from living donors. Of great importance is the quality and function of the donated kidney. Kidneys from living donors and those with normal function can provide better results. In the peri-operative management of the recipient, great attention should be paid to hemodynamic stability and blood pressure; nephrotoxic medicaments should be avoided. Over time, patients with DGF may present lower graft function and survival compared to transplant recipients without DGF. Maladaptation repair, mitochondrial dysfunction, and acute rejection may explain the worse long-term outcome in patients with DGF. Many different strategies meant to prevent DGF have been evaluated, but only prolonged perfusion of dopamine and hypothermic machine perfusion have proven to be of some benefit. Whenever possible, a preemptive transplant from living donor should be preferred.

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Section: Risk Factors For Dgfmentioning

confidence: 99%

Delayed Graft Function in Kidney Transplant: Risk Factors, Consequences and Prevention Strategies

Ponticelli¹,

Reggiani

Moroni

2022

JPM

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“…Although CIT is a known risk factor for DGF, 31 both have been associated with inferior graft survival. 32,33 In our analysis, the effect size of CIT on the incidence of 1-y reduced kidney function was relatively small (1.7% increased risk per additional hour), becoming more relevant after 22 h (28% increased risk). Interestingly, DGF, a major risk factor for graft loss, 32,34 was not associated with reduced 1-y kidney function, even when CIT was removed from the multivariate analysis.…”

Section: Discussionmentioning

confidence: 58%

The Association Between Kidney Donor Profile Index and 1-y Graft Function

Foresto

Hazin

Cassão

et al. 2023

Transplantation Direct

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Background. The association between Kidney Donor Profile Index (KDPI) and 1-y estimated glomerular filtration rate (eGFR) with long-term kidney graft survival is well known. Yet, the association between KDPI and 1-y eGFR remains uncertain considering the several concurrent competing risk factors. Methods. This single-center, retrospective cohort study analyzed data from 3059 consecutive deceased donor kidney transplant recipients with a 1-y follow-up from January 2013 to December 2017. The aim was to determine the association between the KDPI strata (0%–35%, 36%–50%, 51%–85%, 86%–100%) and 1-y eGFR estimated by the CKD-EPI equation. Results. The incidence of delayed graft function (50.6% versus 59.3% versus 62.7% versus 62.0%; P < 0.001) and cytomegalovirus infection (36.7% versus 36.6% versus 43.3% versus 57.8%; P < 0.001) increased with increasing KDPI strata but not biopsy-proven acute rejection (9.1% versus 9.8% versus 8.4% versus 9.1%; P = 0.736). The median 1-y eGFR decreased with increasing KDPI strata (64.8 versus 53.5 versus 46.9 versus 39.1 mL/min/1.73 m 2 ; P < 0.001). In the Cox regression, the higher the KDPI was, the lower the probability of a lower 1-y eGFR was. Assuming the 0%–35% strata as the reference, the likelihood of eGFR <50 mL/min/1.73 m 2 was increased by 76.6% (hazard ratio [HR] = 1.767, 95% confidence interval [CI] = 1.406–2.220), 2.24- and 2.87-fold higher for KDPI higher >35%–50% (HR = 2.239, 95% CI = 1.862–2.691), and >51%–85% (HR = 2.871, 95% CI = 2.361–3.491), respectively. Other variables associated with a lower graft function were donor sex (HR male versus female = 0.896, 95% CI = 0.813–0.989) and cold ischemia time (HR for each hour = 1.011, 95% CI = 1.004–1.019). This association was sustained after the Poisson mediation analysis, including delayed graft function, cytomegalovirus, and acute rejection as mediators. Conclusions. In this cohort of deceased donor kidney recipients, KDPI, and cold ischemia time were the major independent risk factors associated with lower 1-y kidney function.

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“…This has been attributed to superior facilities of better HLA matching and using live donors vs deceased, resulting in less cold ischemia time. 18,19 In addition, including ancillary molecular studies for diagnosing ABMR and identifying at-risk chronic patients has proved helpful worldwide. However, this facility is still under development in our setup.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Histological Patterns of Renal Allograft Biopsies– One Year of Renal Allograft Experience

Ahsan

Asif²,

Chauhan³

et al. 2022

PAFMJ

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Objective: To ascertain the frequency and spectrum of histopathological findings in renal allograft rejection cases received in one year. Study Design: Cross-sectional study. Place and Duration of Study: Histopathology Department of Armed Forces Institute of Pathology, Rawalpindi Pakistan from Jun 2020 to May 2021. Methodology: Renal allograft rejection biopsy cases of 62 male and female patients between the ages of 15-60 years having undergone renal transplant with prior end-stage renal disease over one year were collected. Frequency and histopathological findings were studied after classifying them according to the Banff Classification. Results: Cellular (T-cell mediated) rejection accounted for more than half of the cases under study, making it the most common cause of transplant rejection in our demographical area. It accounted for 28 (45.2%) slides of all the biopsies studied. Antibody-mediated rejection followed next with 17 (27.4%) slides, with seven slides (11.3%) of the cases borderline for changes accounting for a T-Cell mediated rejection. About 10 (16.2%) were non-specific changes negative for transplant rejection criteria. Conclusion: Our study was instrumental in establishing rejection patterns and major rejection sub-types while classified under the Banff Classification in our demographical area. The cataloguing of the cases and the major underlying cause would help minimize rejection rates resulting in better clinical outcomes and increased patient survival.

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Effect of Long Cold Ischemia Time of Kidneys from Aged Donors on Prognosis of Kidney Transplantation

Cited by 8 publications

References 43 publications

Delayed Graft Function in Kidney Transplant: Risk Factors, Consequences and Prevention Strategies

Delayed Graft Function in Kidney Transplant: Risk Factors, Consequences and Prevention Strategies

The Association Between Kidney Donor Profile Index and 1-y Graft Function

Frequency of Histological Patterns of Renal Allograft Biopsies– One Year of Renal Allograft Experience

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