DETERMINATION OF A “SAFE” COLD ISCHEMIC TIME IN KIDNEY TRANSPLANTATION - A COMPARISON OF FIRST AND SECOND KIDNEY TRANSPLANTS FROM THE SAME DECEASED DONOR

Background and objectivesRecent evidence suggests that HLA epitope-mismatching at HLA-DQ loci is associated with the development of anti-DQ donor-specific antibodies and adverse graft outcomes. However, the clinical significance of broad antigen HLA-DQ mismatching for graft outcomes is not well examined.Design, setting, participants, & measurementsUsing the United Network Organ Sharing/the Organ Procurement and Transplantation Network (UNOS/OPTN) data, patients with primary kidney transplants performed between 2005 and 2014 were included. Patients were classified as having either zero HLA-DQ mismatches, or one or two HLA-DQ mismatches. Primary outcomes were death-censored graft survival and incidence of acute rejection.ResultsA total of 93,782 patients were included. Of these, 22,730 (24%) and 71,052 (76%) received zero and one or two HLA-DQ mismatched kidneys, respectively. After adjusting for variables including HLA-ABDR, HLA-DQ mismatching was associated with a higher risk of graft loss in living kidney donor recipients with an adjusted hazard ratio (HR) of 1.18 (95% confidence interval [95% CI], 1.07 to 1.30; P<0.01), but not in deceased kidney donor recipients (HR, 1.05; 95% CI, 0.98 to 1.12; P=0.18) (P value for interaction <0.01). When taking cold ischemic time into account, HLA-DQ mismatching was associated with a higher risk of graft loss in deceased kidney donor recipients with cold ischemic time ≤17 hours (HR, 1.12; 95% CI, 1.02 to 1.27; P=0.002), but not in deceased kidney donor recipients with cold ischemic time >17 hours (HR, 0.97; 95% CI, 0.88 to 1.06; P=0.49) (P value for interaction <0.01). Recipients with one or two HLA-DQ mismatched kidneys had a higher incidence of acute rejection at 1 year, with adjusted odds ratios of 1.13 (95% CI, 1.03 to 1.23; P<0.01) in deceased donor and 1.14 (95% CI, 1.03 to 1.27; P=0.02) in living donor kidney transplant recipients. Specific donor-DQ mismatches seemed to be associated with the risk of acute rejection and graft failure, whereas others did not.ConclusionsHLA-DQ mismatching is associated with lower graft survival independent of HLA-ABDR in living donor kidney transplants and deceased donor kidney transplants with cold ischemia time ≤17 hours, and a higher 1-year risk of acute rejection in living and deceased donor kidney transplants.

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411 Virtual Crossmatch and Cold Ischemic Time in Deceased Donor Kidney Transplantation

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2020.02.413 ◽

2020 ◽

Vol 75 (4) ◽

pp. 656-657

Keyword(s):

Kidney Transplantation ◽

Deceased Donor ◽

Donor Kidney ◽

Ischemic Time ◽

Cold Ischemic Time ◽

Deceased Donor Kidney ◽

Donor Kidney Transplantation ◽

Deceased Donor Kidney Transplantation

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Two cases of kidney transplantation from the same non-heart beating deceased donor after long cold-ischemic time more than 24 h

Clinical Transplantation ◽

10.1111/j.1399-0012.2008.00854.x ◽

2008 ◽

Vol 22 ◽

pp. 72-75

Author(s):

Shinichi Nishi ◽

Naofumi Imai ◽

Yuki Nakagawa ◽

Kazuhide Saito ◽

Kota Takahashi ◽

...

Keyword(s):

Kidney Transplantation ◽

Deceased Donor ◽

Ischemic Time ◽

Cold Ischemic Time ◽

Heart Beating

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Kidney transplant outcomes after medical assistance in dying

Canadian Urological Association Journal ◽

10.5489/cuaj.7304 ◽

2021 ◽

Vol 16 (2) ◽

Author(s):

Patrick P. Luke ◽

Anton Skaro ◽

Alp Sener ◽

Ephraim Tang ◽

Max Levine ◽

...

Keyword(s):

Kidney Transplantation ◽

Large Scale ◽

Graft Function ◽

Delayed Graft Function ◽

Medical Assistance ◽

Ischemic Time ◽

Transplant Outcomes ◽

Medical Assistance In Dying ◽

Cold Ischemic Time ◽

The Mean

Introduction: After nearly four years of Canadian experience with medical assistance in dying (MAiD), the clinical volume of organ transplantation following MAiD remains low. This is the first Canadian report evaluating recipient outcomes from kidney transplantation following MAiD. Methods: This was a retrospective review of the first nine cases of kidney transplants following MAiD at a Canadian transplant center. Results: Nine patients underwent MAiD followed by kidney retrieval during the study period. Their diagnoses were largely neuromuscular diseases. The mean warm ischemic time was 20 minutes (standard deviation [SD] 7). The nine recipients had a mean age of 60 (SD 19.7). The mean cold ischemic time was 525 minutes (SD 126). Delayed graft function occurred in only one patient out of nine. The mean 30-day creatinine was 124 umol/L (SD 52) . The mean three-month creatinine was 115 umol/L (SD 29). Conclusions: We report nine cases of kidney transplantation following MAiD. The process minimized warm ischemia, resulting in low delayed graft function rates, and acceptable post-transplant outcomes. Further large-scale research is necessary to optimize processes and outcomes in this novel clinical pathway.

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COVID-19 and Living Donor Kidney Transplantation in Naples during the Pandemic

BioMed Research International ◽

10.1155/2020/5703963 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Gaia Peluso ◽

Silvia Campanile ◽

Alessandro Scotti ◽

Vincenzo Tammaro ◽

Akbar Jamshidi ◽

...

Keyword(s):

Kidney Transplantation ◽

Living Donor ◽

Viral Infections ◽

Elective Surgery ◽

Deceased Donor ◽

Kidney Transplants ◽

Donor Kidney ◽

Transplant Center ◽

Living Donor Transplantation ◽

Donor Kidney Transplantation

Introduction. SARS-CoV-2 is a virus that causes a potentially deadly syndrome that affects especially the respiratory tract. Kidney-transplanted patients are immunosuppressed and more susceptible to viral infections. We have examined our transplantation activity to explore the future role of kidney transplantation from deceased and living donors in COVID-19 era. Patients and Methods. The activity of our transplant center of Naples (one of the two transplant centers in Campania, South Italy) continued during the COVID-19 pandemic. We have analysed the kidney transplants carried out between March 9 and June 9, 2020, comparing these data with the numbers of procedures performed in the two previous years. Moreover, we have considered the possibility of performing living donor transplants during a worldwide pandemic. Results. From March 9, 2020, when the Italian lockdown begun, till June 9, 2020, five kidney transplants have been performed at our transplant center in Naples, all from deceased donors. The donors and the recipients have been screened for COVID-19 infection, and the patients, all asymptomatic, followed strict preventive measures and were fully informed about the risks of surgery and immunosuppression during a pandemic. All the transplanted patients remained COVID negative during the follow-up. The number of transplants performed has been constant compared to the same months of 2018 and 2019. In agreement with the patients, we decided to postpone living donor transplants to a period of greater control of the SARS-CoV-2 spread in Italy. Conclusion. Deceased donor kidney transplantation should continue, especially in a region with moderate risk, like Campania, with a more careful selection of donors and recipients, preferring standard donors and recipients without severe comorbidities. Living donor transplantation program, instead, should be postponed to a period of greater control of the SARS-CoV-2 spread, as it is an elective surgery and its delay does not determine additional risks for patients.

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Predictors and one-year outcomes of patients with delayed graft function after deceased donor kidney transplantation

BMC Nephrology ◽

10.1186/s12882-020-02181-1 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Rao Chen ◽

Haifeng Wang ◽

Lei Song ◽

Jianfei Hou ◽

Jiawei Peng ◽

...

Keyword(s):

Kidney Transplantation ◽

Graft Survival ◽

Graft Function ◽

Deceased Donor ◽

Donor Kidney ◽

Ischemic Time ◽

Deceased Donor Kidney ◽

One Year ◽

Donor Kidney Transplantation ◽

Deceased Donor Kidney Transplantation

Abstract Background Delayed graft function (DGF) is closely associated with the use of marginal donated kidneys due to deficits during transplantation and in recipients. We aimed to predict the incidence of DGF and evaluate its effect on graft survival. Methods This retrospective study on kidney transplantation was conducted from January 1, 2018, to December 31, 2019, at the Second Xiangya Hospital of Central South University. We classified recipients whose operations were performed in different years into training and validation cohorts and used data from the training cohort to analyze predictors of DGF. A nomogram was then constructed to predict the likelihood of DGF based on these predictors. Results The incidence rate of DGF was 16.92%. Binary logistic regression analysis showed correlations between the incidence of DGF and cold ischemic time (CIT), warm ischemic time (WIT), terminal serum creatine (Scr) concentration, duration of pretransplant dialysis, primary cause of donor death, and usage of LifePort. The internal accuracy of the nomogram was 83.12%. One-year graft survival rates were 93.59 and 99.74%, respectively, for the groups with and without DGF (P < 0.05). Conclusion The nomogram established in this study showed good accuracy in predicting DGF after deceased donor kidney transplantation; additionally, DGF decreased one-year graft survival.

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