scholarly journals Impact of long-distance (up to 3.500 km) deceased donor liver transportation on cold ischemia time, initial graft function and transplant outcomes

2021 ◽  
Vol 13 (1) ◽  
pp. 10-24
Author(s):  
A. I. Sushkov ◽  
K. K. Gubarev ◽  
V. L. Vinogradov ◽  
V. S. Rudakov ◽  
D. S. Svetlakova ◽  
...  
Keyword(s):  
Graft Function ◽  
Deceased Donor ◽  
Interquartile Range ◽  
Cold Ischemia Time ◽  
Cold Ischemia ◽  
Donor Liver ◽  
Long Distance ◽  
Ischemia Time ◽  
Group 2 ◽  
Group 1

Rationale. Currently, a long-distance transportation of the deceased donor livers is not a routine practice for Russian transplantation centers; therefore, a research-based analysis of even relatively small single-center experience seems to be a topical task.The study purpose was to evaluate the impact of long-distance donor liver transportation on the cold ischemia time, the initial graft function as well as on immediate and long-term transplant outcomes.Material and methods. The retrospective single-center study included the data on specific features and results of 72 consecutive deceased donor liver transplantations. The cases were allocated into two groups depending on cold ischemia time: for less than 9 hours (group 1; n = 41) and for 9 hours or longer (group 2; n = 31). The parameters of donor organ transportation, characteristics of donors and recipients, specific features of surgery and the early postoperative period, immediate and long-term outcomes were compared between the groups. For the entire sample size, the relationship between the distance from the donor hospital to the transplant center, the transportation type and time, and the cold ischemia time were assessed.Results. Donor livers were delivered from hospitals 40-3500 km away from the transplant center, including by using regular air flights in 67% of cases. Transportation time varied from 1 to 8 h (median 3.5 h), which made 41% (interquartile range: 35-54%) of cold ischemia time.No statistically significant differences between the groups were seen in the donor, recipient and surgery characteristics. The median distance was 509 km in group 1 (interquartile range 130-1321 km), and 1321 in group 2 (interquartile range 897-3441 km), p<0.001; transportation time was 3.5 h (interquartile range : 2.5–4.7 h) and 3.5 h (interquartile range: 3.3–7.0 h), p = 0.022, the cold ischemia time was 8 h (interquartile range: 7–9.5 h) and 10 hours (interquartile range: 9-10.5 h), p <0.001, in group 1 and group 2, respectively, the difference being statistically significant for all parameters. Despite the tendency to increases in the incidence of the early allograft dysfunction (6/41 in group 1, 9/31 in group 2; p = 0.155), primary graft non-function (1/41 in group 1, 3/31 in group 2; p = 0.308), and the graft loss incidence during the first 6 weeks (4/41 in group 1; 7/31 in group 2; p = 0.189), these differences did not reach the statistical significance.Conclusion. The results of this retrospective study have confirmed the feasibility and clinical efficacy of donor liver transplantation after long-distance transportation. However, cold ischemia time exceeding 9 hours is the risk factor for poor initial graft function.

scholarly journals Immunological induction with thymoglobulin: reduction in the number of doses in renal transplant from deceased donor

2011 ◽  
Vol 9 (1) ◽  
pp. 56-65
Author(s):  
Lucio Roberto Requião Moura ◽  
Eduardo José Tonato ◽  
Érika Arruda Ferraz ◽  
Thiago Corsi Filliponi ◽  
Rogério Chinen ◽  
...  
Keyword(s):  
Negative Impact ◽  
Graft Function ◽  
Cold Ischemia Time ◽  
Cold Ischemia ◽  
Post Transplantation ◽  
Ischemia Time ◽  
Versus Group ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

ABSTRACT Objective: To compare three different regimens of thymoglobulin induction. Methods: One hundred seventy two patients submitted to renal transplantation from a dead donor were divided into three groups according to the total number of thymoglobulin doses used in the post-transplantation surgery: Group 1, until 14 doses - May 2002 to June 2004 (n = 48); Group 2, until 7 doses - July 2004 to December 2006 (n = 57); Group 3, until 4 doses - January 2007 to July 2009 (n = 67). The three groups were compared according to the main outcomes. Results: The main demographic differences among the groups were: greater dialysis time in Group 3 (p < 0.001 for Group 1; and p = 0.04 for Group 2); donor age, greater in Groups 2 and 3 (p = 0.02; p = 0.01, respectively); and cold ischemia time progressively greater from Group 1 to 3: 19.5 ± 5.1 to 24.6 ± 5.7 hours (p < 0.001). In relation to the inhibitor of calcineurin, the relation Tac/Csa was 14.6/66.7% in Group 1, 78.9/12.3% in Group 2 and 100/0% in Group 3. Reflecting the increase in cold ischemia time, the incidence of delayed graft function was 64.6%, 68.4% e 82.1% in Groups 1, 2 and 3, respectively (p = ns). The incidence of acute rejection was similar in the three groups: 16.7% (1); 16.3% (2) and 16.4 (3) - p = ns. The prevalence of viremia for cytomegalovirus was 61.7% in Group 1, 66.1% in Group 2 and 83.3% in Group 3 (p = ns). There were no difference related to the number of infected cells with cytomegalovirus in antigenemia, according to the groups, however, patients in Group 3 had an earlier diagnosis: from 64.3 ± 28.5 days in Grup 2, to 47.1 ± 22.5 days, in Group 3, p < 0.001. Survival of the graft in one year was 89.6%, 92.9% and 91.0%, in Groups 1, 2 and 3, respectively (p = ns). The graft function was much better with the lower doses of thymoglobulin: Group 1: 57.0 ± 20.0 mL/min; Group 2: 67.0 ± 18.4 mL/min (p = 0.008); Group 3: 71.2 ± 18.4 mL/min (p < 0.001, Group 1 versus Group 3; p = 0.06, Group 1 versus Group 2). There was a significant reduction in the costs of induction protocol from U$ 7,567.02 to U$ 3,485.56 (p < 0.001). Conclusions: The total number of thymoglobulin doses for immunologic induction could be reduced in a safe and effective way, without a negative impact in graft rejection or survival, preserving renal function and being significantly cheaper.

scholarly journals Comparison of intraoperative hemodynamic parameters of recipients in adult living donor and deceased donor kidney transplantations

2021 ◽  
pp. 178-183
Author(s):  
Tümay Uludag Yanaral ◽  
Pelin Karaaslan
Keyword(s):  
Living Donor ◽  
Deceased Donor ◽  
Hemodynamic Parameters ◽  
Cold Ischemia Time ◽  
Cold Ischemia ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Objective: There are many studies on kidney transplant anesthesia, there is not enough data in the literature in terms of intraoperative parameters according to the donor type. In this study, we aimed to compare the intraoperative hemodynamic parameters in adult patients who underwent living-donor and deceased-donor kidney transplantation (KT). Material and Methods: The patients who underwent KT were divided into 2 groups according to the donor kidney type. Recipients who underwent deceased donor transplantation were included in the study as Group 1. Among the living donor kidney transplant recipients, the same number of patients with similar demographic data as Group 1 were designated as Group 2. Both groups were compared in terms of recorded data and intraoperative hemodynamic parameters. Results: Twenty-four patients were included in the study. The mean durations of dialysis were 81.6 ± 64.8 and 16.8 ± 17.4 months for Group 1 and Group 2, respectively (p = 0.001). The mean cold ischemia time was significantly longer in Group 1 than Group 2 (p = 0.001). The mean operative urine output for Group 1 and Group 2 were 87.3 ± 149.6 and 634.2 ± 534.5, respectively (p = 0.002). Mean arterial pressure, heart rate, peripheral oxygen saturation and CVP values were all comparable between the two groups. Conclusion: Cold ischemia time is longer and operative urine volume is lower in deceased donor transplants compared to living donor transplants. With good preoperative preparation, close intraoperative follow-up, and proper fluid management, similar intraoperative hemodynamic parameters are achieved in both types of donor recipients. Keywords: Anesthesia, cadaver, hemodynamic monitoring, kidney transplantation, living donors

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

2019 ◽  
Vol 51 (2) ◽  
pp. 321-323 ◽  
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

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

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

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

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.

scholarly journals Donor Age, Cold Ischemia Time, and Delayed Graft Function

2020 ◽  
Vol 15 (6) ◽  
pp. 813-821 ◽  
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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