Abstract
Kidney grafts are often preserved initially in static cold storage (CS) and subsequently on hypothermic machine perfusion (MP). However, the impact of CS/MP time on transplant outcome remains unclear. We evaluated the effect of prolonged CS/MP time in a single-center retrospective cohort of 59 donation after circulatory death (DCD) and 177 matched donation after brain death (DBD) kidney-alone transplant recipients. With mean overall CS/MP times of 6.0 h/30.0 h, overall incidence of delayed graft function (DGF) was higher in DCD transplants (30.5%) than DBD transplants (7.3%, P < 0.0001). In logistic regression, DCD recipient (P < 0.0001), longer CS time (P = 0.0002), male recipient (P = 0.02), and longer MP time (P = 0.08) were associated with higher DGF incidence. In evaluating the joint effects of donor type (DBD vs. DCD), CS time (<6 vs. ≥6 h), and MP time (<36 vs. ≥36 h) on DGF incidence, one clearly sees an unfavorable effect of MP time ≥36 h (P = 0.003) across each donor type and CS time stratum, whereas the unfavorable effect of CS time ≥6 h (P = 0.01) is primarily seen among DCD recipients. Prolonged cold ischemia time had no unfavorable effect on renal function or graft survival at 12mo post-transplant. Long CS/MP time detrimentally affects early DCD/DBD kidney transplant outcome when grafts were mainly preserved by MP; prolonged CS time before MP has a particularly negative impact in DCD kidney transplantation.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1117-1125 |
| Number of pages | 9 |
| Journal | Transplant International |
| Volume | 29 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 1 2016 |
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Keywords
- deceased donor kidney transplantation
- donation after cardiac death
- hypothermic machine perfusion
- ischemia reperfusion injury
- organ preservation
ASJC Scopus subject areas
- Transplantation
Cite this
Negative impact of prolonged cold storage time before machine perfusion preservation in donation after circulatory death kidney transplantation. / Paloyo, Siegfredo; Sageshima, Junichiro; Gaynor, Jeffrey J.; Chen, Linda; Ciancio, Gaetano; Burke, George W.
In: Transplant International, Vol. 29, No. 10, 01.10.2016, p. 1117-1125.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Negative impact of prolonged cold storage time before machine perfusion preservation in donation after circulatory death kidney transplantation
AU - Paloyo, Siegfredo
AU - Sageshima, Junichiro
AU - Gaynor, Jeffrey J.
AU - Chen, Linda
AU - Ciancio, Gaetano
AU - Burke, George W.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Kidney grafts are often preserved initially in static cold storage (CS) and subsequently on hypothermic machine perfusion (MP). However, the impact of CS/MP time on transplant outcome remains unclear. We evaluated the effect of prolonged CS/MP time in a single-center retrospective cohort of 59 donation after circulatory death (DCD) and 177 matched donation after brain death (DBD) kidney-alone transplant recipients. With mean overall CS/MP times of 6.0 h/30.0 h, overall incidence of delayed graft function (DGF) was higher in DCD transplants (30.5%) than DBD transplants (7.3%, P < 0.0001). In logistic regression, DCD recipient (P < 0.0001), longer CS time (P = 0.0002), male recipient (P = 0.02), and longer MP time (P = 0.08) were associated with higher DGF incidence. In evaluating the joint effects of donor type (DBD vs. DCD), CS time (<6 vs. ≥6 h), and MP time (<36 vs. ≥36 h) on DGF incidence, one clearly sees an unfavorable effect of MP time ≥36 h (P = 0.003) across each donor type and CS time stratum, whereas the unfavorable effect of CS time ≥6 h (P = 0.01) is primarily seen among DCD recipients. Prolonged cold ischemia time had no unfavorable effect on renal function or graft survival at 12mo post-transplant. Long CS/MP time detrimentally affects early DCD/DBD kidney transplant outcome when grafts were mainly preserved by MP; prolonged CS time before MP has a particularly negative impact in DCD kidney transplantation.
AB - Kidney grafts are often preserved initially in static cold storage (CS) and subsequently on hypothermic machine perfusion (MP). However, the impact of CS/MP time on transplant outcome remains unclear. We evaluated the effect of prolonged CS/MP time in a single-center retrospective cohort of 59 donation after circulatory death (DCD) and 177 matched donation after brain death (DBD) kidney-alone transplant recipients. With mean overall CS/MP times of 6.0 h/30.0 h, overall incidence of delayed graft function (DGF) was higher in DCD transplants (30.5%) than DBD transplants (7.3%, P < 0.0001). In logistic regression, DCD recipient (P < 0.0001), longer CS time (P = 0.0002), male recipient (P = 0.02), and longer MP time (P = 0.08) were associated with higher DGF incidence. In evaluating the joint effects of donor type (DBD vs. DCD), CS time (<6 vs. ≥6 h), and MP time (<36 vs. ≥36 h) on DGF incidence, one clearly sees an unfavorable effect of MP time ≥36 h (P = 0.003) across each donor type and CS time stratum, whereas the unfavorable effect of CS time ≥6 h (P = 0.01) is primarily seen among DCD recipients. Prolonged cold ischemia time had no unfavorable effect on renal function or graft survival at 12mo post-transplant. Long CS/MP time detrimentally affects early DCD/DBD kidney transplant outcome when grafts were mainly preserved by MP; prolonged CS time before MP has a particularly negative impact in DCD kidney transplantation.
KW - deceased donor kidney transplantation
KW - donation after cardiac death
KW - hypothermic machine perfusion
KW - ischemia reperfusion injury
KW - organ preservation
UR - http://www.scopus.com/inward/record.url?scp=84988884457&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84988884457&partnerID=8YFLogxK
U2 - 10.1111/tri.12818
DO - 10.1111/tri.12818
M3 - Article
C2 - 27421771
AN - SCOPUS:84988884457
VL - 29
SP - 1117
EP - 1125
JO - Transplant International
JF - Transplant International
SN - 0934-0874
IS - 10
ER -