Article
Significant Impact of Prolonged Brain Death Duration on Patient Survival after Kidney Transplantation
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Published: | April 26, 2013 |
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Introduction: In renal transplantation, graft survival using organs from deceased kidney donors is inferior to results after living donation. However, little is known about the effect of brain death duration (BDdur) on long term outcome after kidney transplantation (KTx).
Material and methods: A single-center retrospective analysis of 1245 consecutive deceased donor KTx, carried out between January 2000 and December 2010, was performed. BDdur was calculated as the period between brain death declaration and start of cold perfusion. All recipient-, donor- and transplant-factors, known at the timepoint of KTx, were investigated for their impact on delayed graft function (DGF), acute rejection (AR), „graft loss“ and „death“. Uni- and multivariate statistical analysis were done using binary logistic- and Cox-regression analysis.
Results: Mean BDdur was 12.01 ± 6.26 hours. Recipients which developed DGF received organs from deceased donors with a significant longer BDdur; 12.13 ± 5.815 vs. 11.82 ± 6.177 hours, p=0.0034. BDdur correlated with the occurence of AR inversely, without reaching significance; AR 11.85 ± 6.33 hours vs.12.04 ± 5.997 hours no AR, p=0.156. BDdur did not affect the graft survival, but had a significant impact on patient survival. Beside recipient´s age, BDdur was the most important independent factor for „death“ after KTx; Hazard Ratio (95%CI): 1.041 (1.015-1.067); p=0.002.
Conclusion: BDdur has a significant impact on long term survival after kidney transplantation. This finding represents the importance of optimizing time management prior and during organ retrieval procedures.