TY - JOUR
T1 - Cold ischemia and the reduced long-term survival of cadaveric renal allografts
AU - Salahudeen, Abdulla K.
AU - Haider, Naeem
AU - May, Warren
N1 - Funding Information:
We thank Dr. Henry Barber, Professor of Surgery at the University of Mississippi Medical Center for his critical review of this manuscript. Dr. Salahudeen was funded by the NIH grant RO-1 DK-56835-01 for his research on cold storage–associated organ injury. There was no financial disclosure in connection with this work.
PY - 2004/2
Y1 - 2004/2
N2 - Background. Prolonged cold ischemia time (CIT) is accompanied by delayed cadaveric renal allograft function and early allograft loss, but the effect of CIT on long-term allograft survival is less certain and has not been studied in detail. Methods. Using data from the United Network for Organ Sharing, we identified 6465 patients who received a kidney-only transplant of cadaveric origin for the first time in 1995. We examined the effect of CIT on the 6-year survival of these kidneys using Cox proportional hazard analysis. Results. The mean CIT of the kidney was 21 ± 7 hours (mean ± SD) and correlated with the serum creatinine on discharge (R = 0.20, P < 0.001) and the distance traveled by the kidneys (R = 0.30, P < 0.001). CIT had a significant effect on the 6-year allograft survival (a 10-hour increase in CIT was associated with a hazard risk ratio (RR) of 1.20 for graft failure (P < 0.001) that persisted (RR = 1.40, P = 0.021) after adjusting for donor age, recipient age and race, human leukocyte antigen (HLA) mismatch, panel reactive antibodies, and first 6 months' rejection treatments. Similarly, compared to CIT category of 0 to 10 hours, the 6-year graft survival was progressively worse for 11 to 20 hours (RR = 1.03), 21 to 30 hours (RR = 1.12), and, significantly so, for >30 hours (RR = 1.32; P = 0.011). The gain in HLA match with increasing CIT was not uniform; for instance, HLA match in >30 hours was lower than for 21 to 30 hours (2.4 ± 1.5 vs. 2.7 ± 1.6; P < 0.001). Conclusion. (1) Cadaveric kidneys continue to undergo prolonged periods of cold ischemia; (2) prolonged cold storage is associated with longer distance traveled by the kidneys, but is not associated with any significant gain in tissue matching; and (3) prolonged cold ischemia is a significant predictor of long-term graft loss. Reducing prolonged cold ischemia by regional distribution of organs and less stringent tissue matching may reduce the persistent high rate of long-term loss of cadaveric renal allografts.
AB - Background. Prolonged cold ischemia time (CIT) is accompanied by delayed cadaveric renal allograft function and early allograft loss, but the effect of CIT on long-term allograft survival is less certain and has not been studied in detail. Methods. Using data from the United Network for Organ Sharing, we identified 6465 patients who received a kidney-only transplant of cadaveric origin for the first time in 1995. We examined the effect of CIT on the 6-year survival of these kidneys using Cox proportional hazard analysis. Results. The mean CIT of the kidney was 21 ± 7 hours (mean ± SD) and correlated with the serum creatinine on discharge (R = 0.20, P < 0.001) and the distance traveled by the kidneys (R = 0.30, P < 0.001). CIT had a significant effect on the 6-year allograft survival (a 10-hour increase in CIT was associated with a hazard risk ratio (RR) of 1.20 for graft failure (P < 0.001) that persisted (RR = 1.40, P = 0.021) after adjusting for donor age, recipient age and race, human leukocyte antigen (HLA) mismatch, panel reactive antibodies, and first 6 months' rejection treatments. Similarly, compared to CIT category of 0 to 10 hours, the 6-year graft survival was progressively worse for 11 to 20 hours (RR = 1.03), 21 to 30 hours (RR = 1.12), and, significantly so, for >30 hours (RR = 1.32; P = 0.011). The gain in HLA match with increasing CIT was not uniform; for instance, HLA match in >30 hours was lower than for 21 to 30 hours (2.4 ± 1.5 vs. 2.7 ± 1.6; P < 0.001). Conclusion. (1) Cadaveric kidneys continue to undergo prolonged periods of cold ischemia; (2) prolonged cold storage is associated with longer distance traveled by the kidneys, but is not associated with any significant gain in tissue matching; and (3) prolonged cold ischemia is a significant predictor of long-term graft loss. Reducing prolonged cold ischemia by regional distribution of organs and less stringent tissue matching may reduce the persistent high rate of long-term loss of cadaveric renal allografts.
KW - Cadaveric kidneys
KW - Chronic allograft failure
KW - Chronic allograft nephropathy
KW - Cold ischemia time
KW - Cold preservation
KW - Cold storage
KW - Delayed graft function
KW - HLA match
KW - Kidney transplants
KW - Long-term graft survival
KW - Renal allograft
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U2 - 10.1111/j.1523-1755.2004.00416.x
DO - 10.1111/j.1523-1755.2004.00416.x
M3 - Article
C2 - 14717946
AN - SCOPUS:1642480014
SN - 0085-2538
VL - 65
SP - 713
EP - 718
JO - Kidney International
JF - Kidney International
IS - 2
ER -