THYMOGLOBULINE INDUCTION NULLIFIES THE EFFECT OF COLD ISCHEMIA TIME AND DELAYED GRAFT FUNCTION ON SHORT AND LONG TERM KIDNEY GRAFT SURVIVAL

Abstract Background and Aims Delayed graft function (DGF), defined as the need for dialysis within one week post-transplantation, is associated with poorer kidney graft survival. We aimed to identify risk factors for DGF throughout 3 decades and evaluate their effect on graft survival. Method Retrospective study including 3081 kidney transplants performed at our transplantation unit between January 1st, 1989 and December 31st, 2018, split in 3 decades (1: 1989-1998; 2: 1999-2008; 3: 2009-2018). Data regarding donor and recipient demographics, time on dialysis, immunization, cold ischemia time, hemodynamic parameters and immunosuppression were collected from our prospectively maintained data base. Results Main donor, recipient and perioperative characteristics are summarized in table 1. There were clear differences in these characteristics between the decades, standing out more adverse features from both recipients and donors. Overall incidence rate of DGF was 16% (n=493): 14% in decade 1; 19.3% in decade 2 and 15% in decade 3. On univariate analysis, most studied variables included in table 1 were statistically significant as predictors of DGF. However, on multivariate analysis, we found that in the first decade the predominant risk factors for DGF were pre-transplant dialysis time and cold-ischemia time, whilst in the following decades donor characteristics, as well as recipient’s weight became more relevant (table 2). Conclusion The observed shift from donor-unrelated variables in the first decade into donor-related variables in the second and third decades as the main determinants of DGF highlights the impact of expanding donor’s acceptance criteria. Nevertheless, the increase in expanded criteria donors did not translate into poorer overall results, probable contributors being shorter cold-ischemia times and stronger immunosuppression.

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Donor Age Amplifies the Detrimental Effects of Cold Ischemia Time on Long-Term Kidney Allograft Survival Independently of the Occurrence of Delayed Graft Function or Early Acute Rejection

Experimental and Clinical Transplantation ◽

10.6002/ect.2020.0066 ◽

2020 ◽

Vol 18 (4) ◽

pp. 436-443

Author(s):

Pedro Rincon Cintra da Cruz ◽

Aderivaldo Cabral Dias Filho ◽

Viviane Brandão Bandeira Mello Santana ◽

Rubia Bethania Biela Boaretto ◽

Cassio Luis Zanettini Riccetto

Keyword(s):

Acute Rejection ◽

Graft Function ◽

Delayed Graft Function ◽

Cold Ischemia Time ◽

Donor Age ◽

Allograft Survival ◽

Cold Ischemia ◽

Kidney Allograft ◽

Ischemia Time

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COLD ISCHEMIA TIME SHORTENING BY EARLY LYMPH NODES PROCUREMENT IMPROVES THE EARLY GRAFT FUNCTION, BUT NOT THE LONG-TERM KIDNEY GRAFT FUNCTION

Transplantation Journal ◽

10.1097/00007890-201007272-01760 ◽

2010 ◽

Vol 90 ◽

pp. 898

Author(s):

A. Kolonko ◽

J. Ziaja ◽

R. Krol ◽

J. Chudek ◽

S. Sekta ◽

...

Keyword(s):

Lymph Nodes ◽

Graft Function ◽

Kidney Graft ◽

Cold Ischemia Time ◽

Cold Ischemia ◽

Ischemia Time ◽

Early Graft

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P1702THROMBOTIC MICROANGIOPATHY IN KIDNEY TRANSPLANT RECIPIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1702 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Vojtěch Petr ◽

Petra Hrubá ◽

Roman Šafránek ◽

Jarmila Dedochova ◽

Karel Krejčí ◽

...

Keyword(s):

Graft Survival ◽

Graft Function ◽

National Study ◽

Control Group ◽

Kidney Graft ◽

Cold Ischemia Time ◽

Kidney Transplant Recipients ◽

Cold Ischemia ◽

Ischemia Time ◽

Antibody Mediated Rejection

Abstract Background and Aims Thrombotic microangiopathy (TMA) pathogenesis in kidney transplantation is poorly understood. The aim of this study was to evaluate donor and recipients risk factors for posttransplant TMA. Method In this retrospective multicenter national study, we identified both the case and 3M protocol kidney graft biopsies in 5258 recipients with TMA (n=57, 1.1 %) in 1994-2019. To further evaluate the effect of donor kidney on TMA development, the outcomes of the pair kidney grafts from the identical donors (n=43, 6 living donor, 1 pair kidney discarded, 6 insufficient data) as control group was analyzed. Results TMA occurred in 57 patients at 8th (median) post-operative day. Interestingly, neither histological nor laboratory signs of TMA were present in controls but in one case where TMA was evident in both recipients and in donor zero-hour biopsy. TMA associated with acute antibody mediated rejection was found in 11 cases (19%). Basic demographics between TMA and control group were similar, however longer cold ischemia time (p < 0,05, Figure 1) and more frequent delayed graft function (p < 0,05) were observed in TMA group. Patients with TMA experienced lower death-censored 5-year graft survival (56 vs. 84 %) in comparison with control group (p < 0,05, HR 2,904 (95% CI 1,411; 6,127), Figure 2). Conclusion TMA significantly affects the long-term kidney graft survival. Longer cold ischemia time was identified as the only risk factor and thus recipients genetic background is highly suspected in its pathogenesis.

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Effect of Cold Ischemia Time on Kidney Graft Function and Survival: Differences Between Paired Kidney Transplants From the Same Donor

Transplantation Proceedings ◽

10.1016/j.transproceed.2018.10.012 ◽

2019 ◽

Vol 51 (2) ◽

pp. 321-323 ◽

Cited By ~ 1

Author(s):

J.L. Pérez-Canga ◽

L. Martín Penagos ◽

R. Ballestero Diego ◽

R. Valero San Cecilio ◽

E. Rodrigo Calabia ◽

...

Keyword(s):

Graft Function ◽

Kidney Graft ◽

Cold Ischemia Time ◽

Kidney Transplants ◽

Cold Ischemia ◽

Ischemia Time ◽

Survival Differences

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DELAYED GRAFT FUNCTION PREDICTS LONG-TERM KIDNEY GRAFT SURVIVAL INDEPENDENT OF EARLY ACUTE REJECTION OF DISCHARGE CREATININE

Transplantation Journal ◽

10.1097/00007890-199806270-00372 ◽

1998 ◽

Vol 65 (12) ◽

pp. S91

Author(s):

D. Shoskes ◽

M. Cecka

Keyword(s):

Acute Rejection ◽

Graft Survival ◽

Graft Function ◽

Delayed Graft Function ◽

Kidney Graft

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Donor Age, Cold Ischemia Time, and Delayed Graft Function

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.13711119 ◽

2020 ◽

Vol 15 (6) ◽

pp. 813-821 ◽

Cited By ~ 1

Author(s):

Ilkka Helanterä ◽

Hassan N. Ibrahim ◽

Marko Lempinen ◽

Patrik Finne

Keyword(s):

Graft Function ◽

The United States ◽

Delayed Graft Function ◽

Cold Ischemia Time ◽

Donation After Circulatory Death ◽

Donor Age ◽

Cold Ischemia ◽

Kidney Donor ◽

Ischemia Time ◽

Circulatory Death

Background and objectivesIncreased donor age is one of the most important risk factors for delayed graft function (DGF), and previous studies suggest that the harmful effect of cold ischemia time is increased in kidneys from older donors. Our aim was to study the association of increased donor age and cold ischemia time with the risk of delayed graft function in a large cohort kidney transplants from the current era.Design, setting, participants, & measurementsThe Scientific Registry of Transplant Recipients was used for this observational, retrospective registry analysis to identify all deceased donor kidney transplantations in the United States between 2010 and September 2018, who were on dialysis pretransplantation (n=90,810). The association of donor age and cold ischemia time with the risk of DGF was analyzed in multivariable models adjusted for recipient characteristics (age, race, sex, diabetes, calculated panel-reactive antibodies, pretransplant dialysis duration) and donor characteristics (cause of death, sex, race, body mass index, creatinine, donation after circulatory death status, history of hypertension, and HLA mismatch).ResultsCold ischemia time and donor age were independently associated with the risk of DGF, but the risk of DGF was not statistically significantly lower in donor age categories between 50 and 64 years, compared with donors ≥65 years. The harmful association of cold ischemia time was not higher in kidneys from older donors in any age category, not even among donation after circulatory death donors. When donor risk was assessed with kidney donor profile index, although a statistically significant interaction with cold ischemia time was found, no practically meaningful increase in cold-ischemia susceptibility of kidneys with a high kidney donor profile index was found.ConclusionsWe were unable to demonstrate an association between donor age and DGF. The association of longer cold ischemia time with the risk of DGF was not magnified in older or more marginal donors.

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