The Impact of Combined Warm and Cold Ischemia Time on Post-transplant Outcomes.

Autor:	Foley ME; Faculty of Medicine, Dalhousie University, Halifax, NS, Canada., Vinson AJ; Nova Scotia Health, Halifax, Canada.; Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Canada., Skinner TAA; Nova Scotia Health, Halifax, Canada.; Department of Urology, Dalhousie University, Halifax, NS, Canada., Kiberd BA; Nova Scotia Health, Halifax, Canada.; Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Canada., Tennankore KK; Nova Scotia Health, Halifax, Canada.; Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Canada.
Jazyk:	angličtina
Zdroj:	Canadian journal of kidney health and disease [Can J Kidney Health Dis] 2023 Jun 11; Vol. 10, pp. 20543581231178960. Date of Electronic Publication: 2023 Jun 11 (Print Publication: 2023).
DOI:	10.1177/20543581231178960
Abstrakt:	Background: Prolonged warm ischemia time (WIT) and cold ischemia time (CIT) are independently associated with post-transplant graft failure; their combined impact has not been previously studied. We explored the effect of combined WIT/CIT on all-cause graft failure following kidney transplantation. Methods: The Scientific Registry of Transplant Recipients was used to identify kidney transplant recipients from January 2000 to March 2015 (after which WIT was no longer separately reported), and patients were followed until September 2017. A combined WIT/CIT variable (excluding extreme values) was separately derived for live and deceased donor recipients using cubic splines; for live donor recipients, the reference group was WIT 10 to <23 minutes and CIT >0 to <0.42 hours, and for deceased donor recipients the WIT was 10 to <25 minutes and CIT 1 to <7.75 hours. The adjusted association between combined WIT/CIT and all-cause graft failure (including death) was analyzed using Cox regression. Secondary outcomes included delayed graft function (DGF). Results: A total of 137 125 recipients were included. For live donor recipients, patients with prolonged WIT/CIT (60 to ≤120 minutes/3.04 to ≤24 hours) had the highest adjusted hazard ratio (HR) for graft failure (HR = 1.61, 95% confidence interval [CI] = 1.14-2.29 relative to the reference group). For deceased donor recipients, a WIT/CIT of 63 to ≤120 minutes/28 to ≤48 hours was associated with an adjusted HR of 1.35 (95% CI = 1.16-1.58). Prolonged WIT/CIT was also associated with DGF for both groups although the impact was more driven by CIT. Conclusions: Combined WIT/CIT is associated with graft loss following transplantation. Acknowledging that these are separate variables with different determinants, we emphasize the importance of capturing WIT and CIT independently. Furthermore, efforts to reduce WIT and CIT should be prioritized. Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: KKT has conducted CME/Advisory board activities for Baxter, Bayer, Astra Zeneca, Outsuka, and GlaxoSmith Kline. AJV has accepted investigator-initiated fellowship grant funding and consultancy funding from Paladin Labs Inc. (© The Author(s) 2023.)
Databáze:	MEDLINE
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