Article
Time matters: thresholds for cold ischemia time and anastomosis time in kidney transplant recipients >65 years
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Published: | April 21, 2016 |
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Outline
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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.