The Impact of Anastomosis Time During Kidney Transplantation on Graft Loss: A Eurotransplant Cohort Study

Abstract

Recent studies raised the concern that warm ischemia during completion of vascular anastomoses in kidney implantation harms the transplant, but its precise impact on outcome and its interaction with other risk factors remain to be established. We investigated the relationship between anastomosis time and graft survival at 5 years after transplantation in 13 964 recipients of deceased donor solitary kidney transplants in the Eurotransplant region. Anastomosis time was independently associated with graft loss after adjusting for other risk factors (adjusted hazard ratio [HR] 1.10 for every 10-min increase, 95% confidence interval [CI] 1.06-1.14; p < 0.0001), whereas it did not influence recipient survival (HR 1.00, 95% CI 0.97-1.02). Kidneys from donation after circulatory death (DCD) were less tolerant of prolonged anastomosis time than kidneys from donation after brain death (p = 0.02 for interaction). The additive effect of anastomosis time with donor warm ischemia time (WIT) explains this observation because DCD status was no longer associated with graft survival when adjusted for this summed WIT, and there was no interaction between DCD status and summed WIT. Time to create the vascular anastomoses in kidney transplantation is associated with inferior transplant outcome, especially in recipients of DCD kidneys.

Duration of delayed graft function and outcomes after kidney transplantation from controlled donation after circulatory death donors: a retrospective study

“…Interestingly, warm ischaemic time was not associated with graft outcomes in our study. Anastomosis time did not have a significant impact on duration of DGF or longer term graft outcomes, though this association has been demonstrated in a recent large study [42].…”

Adult Liver Allocation in Eurotransplant

“…The availability of a reliable large registry in Eurotransplant would contribute to improved patient management within its own region and current data are already being used for this purpose. 37,38 Furthermore, it creates the potential to facilitate the conduct of international donor management and preservation trials when primary outcome measures are captured in a registry, as was done recently by Niemann et al…”

CD47 blockade reduces ischemia/reperfusion injury in donation after cardiac death rat kidney transplantation

“…Compared with DBD donors, longer warm ischemia times after cardiac arrest in DCD donor reduce oxygen and nutrient supply to the tissues, leading increased IRI and reduced kidney quality. A recent study reported that greater warm ischemia times are associated with higher rates of graft failure and mortality after kidney transplantation (6, 7). IRI can also lead to progressive graft dysfunction with chronic fibroinflammatory changes that impacts long-term graft survival (8, 9).…”

“…A recent study reported that greater warm ischemia times are associated with higher rates of graft failure and mortality after kidney transplantation. 6,7 IRI can also lead to progressive graft dysfunction with chronic fibroinflammatory changes that impact longterm graft survival. 8,9 It is therefore essential to develop strategies to prevent or ameliorate IRI and improve the quality of DCD allografts.…”