Donor Time to Death and Kidney Transplant Outcomes in the Setting of a 3-Hour Minimum Wait Policy.

Autor:	Tingle SJ; National Institute of Health and Care Research Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, United Kingdom.; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.; Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom., Chung NDH; National Institute of Health and Care Research Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, United Kingdom., Malik AK; National Institute of Health and Care Research Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, United Kingdom.; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.; Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom., Kourounis G; National Institute of Health and Care Research Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, United Kingdom.; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.; Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom., Thompson E; National Institute of Health and Care Research Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, United Kingdom.; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.; Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom., Glover EK; National Institute of Health and Care Research Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, United Kingdom.; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.; Renal Services, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom., Mehew J; Statistics and Clinical Research, NHS Blood and Transplant, Bristol, United Kingdom., Philip J; Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison., Gardiner D; Deceased Organ Donation, NHS Blood and Transplant, Bristol, United Kingdom.; Consultant in Adult Intensive Care Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom., Pettigrew GJ; Department of Surgery, University of Cambridge, Cambridge, United Kingdom., Callaghan C; Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom., Sheerin NS; National Institute of Health and Care Research Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, United Kingdom.; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.; Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom.; Renal Services, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom., Wilson CH; National Institute of Health and Care Research Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, United Kingdom.; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.; Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2024 Nov 04; Vol. 7 (11), pp. e2443353. Date of Electronic Publication: 2024 Nov 04.
DOI:	10.1001/jamanetworkopen.2024.43353
Abstrakt:	Importance: Lengthening waiting lists for organ transplant mandates the development of strategies to expand the deceased donor pool. Due to concerns regarding organ viability, most organ donation organizations internationally wait no longer than 1 to 2 hours for potential donation after circulatory death (DCD), possibly underutilizing an important organ source; UK policy mandates a minimum 3-hour wait time. Objective: To assess whether time to death (TTD) from withdrawal of life-sustaining treatment (WLST) is associated with kidney transplant outcomes. Design, Setting, and Participants: This population-based cohort study used data from the prospectively maintained UK Transplant Registry from all 23 UK kidney transplant centers from January 1, 2013, to December 31, 2021; follow-up was until the date of data extraction (October 2023). Participants comprised 7183 adult recipients of DCD kidney-alone transplants. Exposure: Duration of TTD, defined as time from WLST to donor mechanical asystole. Main Outcomes and Measures: Primary outcome was 12-month estimated glomerular filtration rate (eGFR; for the main eGFR model, variables with significant right skew [histogram visual assessment] were analyzed on the log2 scale), with secondary outcomes of delayed graft function and graft survival (censored at death or 5 years). Results: This study included 7183 kidney transplant recipients (median age, 56 years [IQR, 47-64 years]; 4666 men [65.0%]). Median donor age was 55 years (IQR, 44-63 years). Median TTD was 15 minutes (range, 0-407 minutes), with 885 kidneys transplanted from donors with TTD over 1 hour and 303 kidneys transplanted from donors with TTD over 2 hours. Donor TTD was not associated with recipient 12-month eGFR on adjusted linear regression (change per doubling of TTD, -0.25; 95% CI, -0.68 to 0.19; P = .27), nor with delayed graft function (adjusted odds ratio, 1.01; 95% CI, 0.97-1.06; P = .65) or graft survival (adjusted hazard ratio, 1.00; 95% CI, 0.95-1.07; P = .92). These findings were confirmed with restricted cubic spline models (assessing nonlinear associations) and tests of interaction (including normothermic regional perfusion). In contrast, donor asystolic time, cold ischemic time, and reperfusion time were independently associated with outcomes. Compared with a theoretical 1-hour maximum wait time, the UK policy (minimum 3-hour wait time) has been associated with 885 extra DCD transplants compared with 6298 transplants (14.1% increase). Conclusions and Relevance: In this cohort study of DCD kidney recipients, donor TTD was not associated with posttransplant outcomes, in contrast to subsequent ischemic times. Altering international transplant practice to mandate minimum 3-hour donor wait times could substantially increase numbers of kidney transplants performed without prejudicing outcomes.
Databáze:	MEDLINE
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