Abstract
Kidney biopsy is performed to assess if an extended criteria graft can be used for transplantation. It may be performed before or after cross-clamping during organ procurement. This study aims to evaluate whether the timing of biopsy may modify cold ischemia times (CIT) and/or graft outcomes. Kidney transplants performed in our centre from January 2007 to December 2017 were analysed. Grafts with pre-implantation kidney biopsy were included. Biopsies were performed during surgical back table (ESKB, ex-situ kidney biopsy) until 2012 and since then, before the aortic cross-clamping (ISKB, in situ kidney biopsy). To overcome biases owing to different distribution, a propensity score model was developed. The study population consists in 322 patients, 115 ESKB and 207 ISKB. Cold ischemia time was significantly lower for ISKB (730 min ISKB vs. 840 min ESKB, p-value = 0.001). In both crude (OR 0.27; 95% Confidence Interval, 95% CI 0.12–0.60; p-value = 0.002) and adjusted analyses (OR 0.37; 95% CI 0.14–0.94; p-value = 0.039), ISKB was associated with a reduced odd of graft loss when compared to ESKB. Performing pre-implantation kidney biopsy during the recovery, prior to the aortic cross-clamping, may be a strategy to reduce cold ischemia time and improve transplant outcomes.
The impact of the angioplasty of the renal artery and cold ischemia time in kidney transplantation on graft function