title: Impact of cold ischemia time on initial graft function and survival rates in renal transplants from deceased donors performed in Andalusia.
abstract: BACKGROUND
  Prolonged cold ischemic time (CIT) in cadaveric renal transplants has been associated with a high rate of delayed graft function, acute rejection, and even reduced graft survival. We analyzed the influence of CIT on both initial graft function (IGF) and survival rate.
  
  
  METHODS
  We studied 2525 noncombined cadaveric cases in recipients over 17 years of age between 2000 and 2008, using data from the renal transplant records of Andalusia. We defined IGF as the need to resume dialysis within the first week or a nonfunctional kidney. The multivariate analyses were corrected by center and year of transplantation.
  
  
  RESULTS
  The mean and median cold ischemic time was 17 hours. The duration of CIT was significantly associated (P < .001) with older donor and recipient age. The frequency of IGF increased progressively with longer CIT and older donors. However, the influence of CIT persisted among all donor age strata. Logistic regression analysis using both donor and recipient age as covariables showed a relative risk per hour of 1.05 (95% confidence interval = 1.04-1.07; P < .0001). In a univariable study, longer CIT led to a significant reduction in both recipient and graft survival rates. The multivariate study (Cox) using preprocedure covariables, showed CIT to produce significantly worse survival rates for both recipients (relative risk: 1.03, 1.005-1.05, P = .02) and for grafts (relative risk: 1.03, 1.01-1.04, P = .002). However, the survival rates showed no clear progression in terms of CIT within each individual donor age stratum.
  
  
  CONCLUSIONS
  A longer CIT was associated with an increase in IGF independent of the age of both the donor and the recipient. Our data also suggested that CIT influenced patient and graft survival rates.
authors.affiliation: Transplant Coordination Center, Andalusian Health Service, Seville, Spain. miguel.perez.sspa@juntadeandalucia.es
authors.forename: M A
authors.initials: MA
authors.lastname: Pérez Valdivia
authors.forename: M A
authors.initials: MA
authors.lastname: Gentil
authors.forename: M
authors.initials: M
authors.lastname: Toro
authors.forename: M
authors.initials: M
authors.lastname: Cabello
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez-Benot
authors.forename: A
authors.initials: A
authors.lastname: Mazuecos
authors.forename: A
authors.initials: A
authors.lastname: Osuna
authors.forename: M
authors.initials: M
authors.lastname: Alonso
mesh_terms: D000328:Adult; D000367:Age Factors; D050377:Cold Ischemia / Q000009:adverse effects*; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome