gms | German Medical Science

133. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

26.04. - 29.04.2016, Berlin

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Time matters: thresholds for cold ischemia time and anastomosis time in kidney transplant recipients >65 years

Meeting Abstract

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  • Christian Denecke - Charite Universitätsmedizin, Allgemein -, Viszeral- und Transplantationschirurgie, Berlin, Deutschland
  • Matthias Biebl - Charite Universitätsmedizin, Allgemein -, Viszeral- und Transplantationschirurgie, Berlin, Deutschland
  • Andreas Brandl - Charite Universitätsmedizin, Klinik für Allgemein-, Visceral-, Gefäß- und Thoraxchirurgie, Berlin, Deutschland
  • Sascha Weiss - Charite Universitätsmedizin, Klinik für Allgemein-, Visceral-, Gefäß- und Thoraxchirurgie, Berlin, Deutschland
  • Claudia Bösmüller - Medizinische Universität Innsbruck, Viszeral, Transplantations – und Thoraxchirurgie,, Innsbruck, Austria
  • Felix Aigner - Charite Universitätsmedizin, Allgemein -, Viszeral- und Transplantationschirurgie, Berlin, Deutschland
  • Tomasz Dziodzio - Charite Universitätsmedizin, Allgemein -, Viszeral- und Transplantationschirurgie, Berlin, Deutschland
  • Robert Sucher - Charite Universitätsmedizin, Allgemein -, Viszeral- und Transplantationschirurgie, Berlin, Deutschland
  • Johann Pratschke - Charite Universitätsmedizin, Allgemein -, Viszeral- und Transplantationschirurgie, Berlin, Deutschland
  • Robert Öllinger - Charite Universitätsmedizin, Allgemein -, Viszeral- und Transplantationschirurgie, Berlin, Deutschland

Deutsche Gesellschaft für Chirurgie. 133. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 26.-29.04.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. Doc16dgch106

doi: 10.3205/16dgch106, urn:nbn:de:0183-16dgch1069

Veröffentlicht: 21. April 2016

© 2016 Denecke et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Background: In kidney transplantation (Ktx), the association of cold ischemia time (CIT), anastomosis time (AT) and delayed graft function (DGF) is particularly detriemental in grafts from marginal donors; yet, actual cut-off criteria are still debated.

Materials and methods: Data from patients >65years (n=193) and patients <65years (n=1054) transplanted between 2000 and 2010, were retrospectively analyzed regarding the age-dependent impact of ischemia times and DGF.

Results: Overall death censored graft survival was inferior for ECD/DCD organs. In addition, graft survival was further impaired by DGF in younger and older recipients (p<0.05 and p<0.005). The multivariate analysis revealed an age-dependent profile of risk factors for DGF. In younger patients, multiple risk factors were identified while in patients >65years, only CIT and AT were correlated with DGF. Consequently, the impact of CIT and AT in elderly patients was further analysed. Marginal grafts with a CIT<769min had a comparable outcome to any SCD organ; extended CIT over 770min worsened ECD/DCD survival significantly Similarly, AT longer than 26min was associated with a significantly impaired survival of ECD/DCD. In a cox regression analysis with penalized splines, a CIT beyond 800min and an AT beyond 20min were cut-off values associated with worse outcomes in marginal organs. Importantly, this increase in risk of graft loss was not linear but included a distinct threshold.

Conclusion: Risk factors for DGF are age-dependent; CIT and AT are crucial determinants of marginal graft outcome. Keeping ischemia times below certain thresholds offers comparable outcome of ECD/DCD organs.