Donor Age, Cold Ischemia Time, and Delayed Graft Function

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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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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Impact of Cold Ischemia Time in Kidney Transplants From Donation After Circulatory Death Donors

Transplantation Direct ◽

10.1097/txd.0000000000000680 ◽

2017 ◽

Vol 3 (7) ◽

pp. e177 ◽

Cited By ~ 8

Author(s):

Liise Kayler ◽

Xia Yu ◽

Carlos Cortes ◽

Michelle Lubetzky ◽

Patricia Friedmann

Keyword(s):

Cold Ischemia Time ◽

Donation After Circulatory Death ◽

Kidney Transplants ◽

Cold Ischemia ◽

Ischemia Time ◽

Circulatory Death

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

Transplantation Journal ◽

10.1097/00007890-199904150-00659 ◽

1999 ◽

Vol 67 (7) ◽

pp. S165 ◽

Cited By ~ 1

Author(s):

D Glotz ◽

C Antoine ◽

B Pegaz ◽

A Duboust ◽

J Bariety

Keyword(s):

Graft Survival ◽

Graft Function ◽

Delayed Graft Function ◽

Kidney Graft ◽

Cold Ischemia Time ◽

Cold Ischemia ◽

Ischemia Time ◽

Short And Long Term

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Donor Death Category Is an Effect Modifier Between Cold Ischemia Time and Post-transplant Graft Function in Deceased-Donor Kidney Transplant Recipients

Frontiers in Medicine ◽

10.3389/fmed.2021.743085 ◽

2021 ◽

Vol 8 ◽

Author(s):

You Luo ◽

Zhanwen Dong ◽

Xiao Hu ◽

Zuofu Tang ◽

Jinhua Zhang ◽

...

Keyword(s):

Brain Death ◽

Graft Function ◽

Potential Effect ◽

Cold Ischemia Time ◽

Cold Ischemia ◽

Effect Modifier ◽

Ischemia Time ◽

Post Transplant ◽

Donation After Brain Death ◽

Circulatory Death

Objectives: We aimed to analyze the effect of cold ischemia time (CIT) on post-transplant graft function through mixed-effect model analysis to reduce the bias caused by paired mate kidneys.Methods: We reviewed all kidney transplantation records from 2015 to 2019 at our center. After applying the exclusion criteria, 561 cases were included for analysis. All donor characteristics, preservation and matching information, and recipient characteristics were collected. Transplant outcomes included delayed graft function (DGF) and estimated glomerular filtration rate (eGFR). Generalized linear mixed models were applied for analysis. We also explored potential effect modifiers, namely, donor death category, expanded criteria donors, and donor death causes.Results: Among the 561 cases, 79 DGF recipients developed DGF, and 15 recipients who died after surgery were excluded from the eGFR estimation. The median stable eGFR of the 546 recipients was 60.39 (47.63, 76.97) ml/min/1.73 m2. After adjusting for confounding covariates, CIT had a negative impact on DGF incidence [odds ratio = 1.149 (1.006, 1.313), P = 0.041]. In the evaluation of the impact on eGFR, the regression showed that CIT had no significant correlation with eGFR [β = −0.287 (−0.625, 0.051), P = 0.096]. When exploring potential effect modifiers, only the death category showed a significant interaction with CIT in the effect on eGFR (Pinteraction = 0.027). In the donation after brain death (DBD) group, CIT had no significant effect on eGFR [β = 0.135 (−0.433, 0.702), P = 0.642]. In the donation after circulatory death/donation after brain death followed by circulatory death (DCD/DBCD) group, CIT had a significantly negative effect on eGFR [β= −0.700 (−1.196, −0.204), P = 0.006]. Compared to a CIT of 0–6 h, a CIT of 6–8 or 8–12 h did not decrease the post-transplant eGFR. CIT over 12 h (12–16 h or over 16 h) significantly decreased eGFR. With the increase in CIT, the regenerated eGFR worsened (Ptrend = 0.011).Conclusion: Considering the effect of paired mate kidneys, the risk of DGF increased with prolonged CIT. The donor death category was an effect modifier between CIT and eGFR. Prolonged CIT did not reduce the eGFR level in recipients from DBDs but significantly decreased the eGFR in recipients from DCDs/DBCDs. This result indicates the potential biological interaction between CIT and donor death category.

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Reduction of Cold Ischemia Time and Anastomosis Time Correlates with Lower Delayed Graft Function Rates Following Transplantation of Marginal Kidneys

Annals of Transplantation ◽

10.12659/aot.896672 ◽

2016 ◽

Vol 21 ◽

pp. 246-255 ◽

Cited By ~ 8

Author(s):

Christian Denecke ◽

Matthias Biebl ◽

Josef Fritz ◽

Andreas Brandl ◽

Sascha Weiss ◽

...

Keyword(s):

Graft Function ◽

Delayed Graft Function ◽

Cold Ischemia Time ◽

Cold Ischemia ◽

Ischemia Time

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A successful strategy for achieving minimal cold ischemia time for Donation after Circulatory Death in Belfast City Hospital

Journal of Nephrology and Hypertension ◽

10.33582/2637-9619/1005 ◽

2018 ◽

Vol 1 (1) ◽

Author(s):

Mahendra N Mishra ◽

◽

Aisling Courtney ◽

Bernadette Magee ◽

Miceal Cole ◽

...

Keyword(s):

City Hospital ◽

Cold Ischemia Time ◽

Donation After Circulatory Death ◽

Cold Ischemia ◽

Belfast City Hospital ◽

Ischemia Time ◽

Successful Strategy ◽

Circulatory Death

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MO942PREDICTORS OF DELAYED GRAFT FUNCTION IN KIDNEY TRANSPLANT RECIPIENTS THROUGHOUT 3 DECADES: A SINGLE-CENTER EXPERIENCE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab110.0021 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Carolina Figueiredo ◽

Mariana Fernandes ◽

Filipe Mira ◽

Clara Pardinhas ◽

Rita Leal ◽

...

Keyword(s):

Risk Factors ◽

Graft Survival ◽

Univariate Analysis ◽

Graft Function ◽

Delayed Graft Function ◽

Kidney Graft ◽

Cold Ischemia Time ◽

Cold Ischemia ◽

Ischemia Time ◽

The Impact

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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