Impact of cold ischemia time on renal allograft outcome using kidneys from young donors

Transpl Int. 2008 Oct;21(10):955-62. doi: 10.1111/j.1432-2277.2008.00708.x. Epub 2008 Jun 24.

Abstract

Prolonged cold ischemia time (CIT) is associated with delayed graft function and worse kidney transplant (KT) outcome, but the effect of CIT on long-term allograft survival in KT from younger donors has not been well established. We investigated the predictive value of CIT exposure on long-term death-censored graft loss in 829 KT recipients from younger donors (<50 years) that were performed in our center between 1991 and 2005. Overall death-censored graft failure rate was significantly higher in CIT>or=19 h group versus CIT<19 h group (26 vs. 16.5%; P = 0.002). Significant differences were also observed when patients with primary nonfunctioning graft were excluded (21 vs. 14%; P = 0.020) and in patients who received tacrolimus plus mycophenolate mofetil (12 vs. 4%; P = 0.05). By multivariate Cox analysis, CIT was found to be independently associated with death-censored graft loss with a 20% increase for every 5 h of CIT [relative risk (RR) 1.04; 95% Confidence Interval (CI): 1.01-1.1; P = 0.021]. Likewise, graft loss risk significantly increased in CIT>or=19 h group versus CIT<19 h group (RR 1.5; 95%CI: 1.1-2.1; P = 0.023). Prolonged CIT is an independent predictor of graft survival in KT from younger donors. Efforts at minimizing CIT (<19 h) should improve transplant outcome significantly in this population.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Cold Ischemia / methods*
  • Female
  • Follow-Up Studies
  • Graft Rejection / epidemiology
  • Graft Rejection / prevention & control*
  • Graft Survival / physiology*
  • Humans
  • Incidence
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation / methods*
  • Male
  • Prognosis
  • Retrospective Studies
  • Spain / epidemiology
  • Survival Rate / trends
  • Time Factors
  • Treatment Outcome