Impact of Prolonged Cold Ischemia Time on One Year Kidney Transplant Outcomes

Fletchinger, Teresa; Jensen, Hanna K.; Wells, Allison; Giorgakis, Emmanouil; Patel, Raj B.; Barone, Gary W.; Khan, Nasir; Burdine, Marie Schluterman; Sharma, Aman; Bhusal, Sushma; Burdine, Lyle

doi:10.1016/j.transproceed.2022.08.019

Cited by 2 publications

(2 citation statements)

References 11 publications

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“…Mean ischemia time was 17.97 h, with a range of 6-29 h, and in line with data from large samples published in the literature [22] and was longer in TCpost11. With regards to cold ischemia time, some studies deny any impact on the recipient if cold ischemia time is less than 16 h [23], while Gorayeb-Polacchini, FS et al found no significant differences between patients whose grafts had a cold ischemia time over versus under 20 h [24], and still, other series report that cold ischemia time above 36 h is not associated with worse outcomes in terms of kidney function [25]. In a retrospective study with outcomes of kidney transplant from deceased donors with acute kidney injury and prolonged cold ischemia time, an increased delay in kidney function if those 36 h are exceeded [26] is described, with a consequent increase in hospitalisation time [27], although Vinson, AJ.…”

Section: Discussionmentioning

confidence: 99%

Enhancing Kidney Transplant Outcomes: The Impact of Living Donor Programs

Noya-Mourullo,

Martín-Parada,

Palacios-Hernández

et al. 2024

JPM

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Introduction: The protocol for deceased donor kidney transplants has been standardised. The procedure for a living donor has peculiarities derived from the differences in the graft. When a living kidney donor program is implemented, changes occur in both the profile of the kidney transplant candidate and in the postoperative treatments. Aims: To discover whether a living donor program influences the functional outcomes of kidney grafts in a longstanding classical deceased donor kidney transplant program and to identify the factors associated with transplant outcomes. Methods: Retrospective observational multicentre study. Sample: Kidney transplant patients in two urology referral centres for renal transplant in Spain between 1994 and 2019. Groups: TV (living transplant): patients given kidney transplants from living donors (n = 150); TCpre11 (deceased transplant previous to 2011): patients given kidney transplants from deceased donors before the living donor program was implemented (n = 650); and TCpost11 (deceased transplant after 2011): patients given kidney transplants from deceased donors after the living donor program was implemented (n = 500). Results: Mean age was 55.75 years (18–80 years), higher in TCpre11. There were 493 female patients (37.92%) and 1007 male patients (62.08%). Mean body mass index (BMI) was 26.69 kg/m2 (17.50–42.78 kg/m2), higher in TCpre11. Mean ischemia time was 17.97 h (6–29 h), higher in TCpost11. Median duration of urethral catheter: 8 days (6–98 days), higher in TCpost11. Median duration of double-J ureteral stent: 58 days (24–180 days), higher in TCpost11. Pretransplant UTIs: 17.77%, higher in TCpre11 (25.69%) than in TV (12%), higher in TV (12%) than TCpost11 (9.2%), and higher in TCpre11 (25.69%) than TCpost11 (9.2%). Acute renal rejection in 9.33% of TV, 14.77% of TCpre11, and 9.8% of TCpost11. Multivariate analysis: TCpost11 featured higher BMI, more smoking, and chronic renal failure progression time. Lower use of nonantibiotic prophylaxis to prevent recurrent urinary tract infections, increased duration of urethral catheters due to obstructive problems, and favoured deterioration of kidney function was observed in the deceased donor program. The living donor (LD) program had a strong influence on deceased donor transplants in the prelysis phase. Implementation of a LD program was associated with a decrease in the likelihood of acute rejection in TCpost11 and an increase in the tendency towards normal kidney function. Conclusions: Implementing living donor transplant programs affects functional outcomes in deceased donor transplants, reducing the probability of acute rejection and increasing the tendency towards normal kidney function. Preventing recurrent urinary tract infections with measures other than antibiotics, smoking cessation, delaying the removal of the double-J stent from the graft, and pre-emptive transplant (transplant prior to dialysis) are associated with improved renal function of the graft.

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Section: Discussionmentioning

confidence: 99%

Enhancing Kidney Transplant Outcomes: The Impact of Living Donor Programs

Noya-Mourullo,

Martín-Parada,

Palacios-Hernández

et al. 2024

JPM

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“…2 One of the major challenges of deceased organ transplant is its time-sensitive nature. 3 Prolonged cold ischemia time (CIT) is known to be accompanied by delayed graft function (DGF) and early graft loss after traditional open kidney transplant (OKT). 4 The effect of CIT in the setting of robotic kidney transplantation is less certain and has not been studied in detail.…”

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confidence: 99%

Analyzing the Impact of CIT on the Largest Reported Cohort of Robotic Kidney Transplantation From the Deceased Donors

Petrochenkov,

Bencini,

Martinino

et al. 2024

Transplantation Direct

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Background. Robotic-assisted kidney transplant (RAKT) has proven to be a successful approach for patients with morbid obesity and more centers are encouraged to apply robotic approach also for deceased donor kidney transplantation. Prolonged cold ischemia time (CIT) is accompanied by delayed graft function (DGF) and early graft loss after traditional open kidney transplant (OKT). This study examines the impact of CIT after robotic kidney transplantation on settings of deceased donation. Methods. We present a single-center retrospective analysis of 115 cases of RAKT and 128 cases of OKT from deceased donors performed from deceased donor from 2009 to July 2022. Cohort was divided in 3 groups based on CIT (“high” CIT > 15 h, n = 43; “medium” CIT 11–15 h, n = 38; “low” CIT< 11 h, n = 40). The subgroup analysis of DGF and CIT was performed. Results. The median CIT in the cohort was 13.46 (7) h, and overall rate of DGF was 30.6%. The correlation between CIT and DGF was statistically significant (P = 0.008), and DGF negatively correlated with 1-y graft survival (P = 0.04). The rate of DGF was significantly different between the groups (P = 0.05). Conclusions. Results from our study demonstrate that the effect of CIT on DGF in settings of RAKT follows a similar pattern as in traditional OKT.

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Impact of Prolonged Cold Ischemia Time on One Year Kidney Transplant Outcomes

Cited by 2 publications

References 11 publications

Enhancing Kidney Transplant Outcomes: The Impact of Living Donor Programs

Enhancing Kidney Transplant Outcomes: The Impact of Living Donor Programs

Analyzing the Impact of CIT on the Largest Reported Cohort of Robotic Kidney Transplantation From the Deceased Donors

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