title: The impact of vascular anastomosis time on early kidney transplant outcomes.
abstract: BACKGROUND
  Most studies have found cold ischemic time to be an important predictor of delayed graft function in kidney transplantation. Relatively less is known about the warm time associated with vascular anastomosis and early outcomes.
  
  
  METHODS
  A retrospective cohort of 298 consecutive solitary deceased donor kidney recipients from January 2006 to August 2012 was analyzed to examine the association between anastomosis time and delayed graft function (need for dialysis) and length of hospital stay.
  
  
  RESULTS
  Delayed graft function (DGF) was observed in 56 patients (18.8%). The median anastomosis time was 30 minutes (interquartile range 24, 45 minutes). Anastomosis time was independently associated with DGF in a multivariable, binary logistic regression analysis (odds Ratio (OR) 1.037 per minute, 95% CI 1.016, 1.057, P = 0.001). An anastomosis time >29 minutes was also associated with a 3.5 fold higher (OR 3.5, 95% CI 1.6, 7.3, P = 0.001) risk of DGF. Median days in hospital was 9 (interquartile range 7, 14 days). Every 5 minutes of longer anastomosis time (0.20 days per minute, 95% CI 0.13, 0.27, P <0.001) was associated with 1 extra day in hospital in a multivariable linear regression model. An anastomosis time >29 minutes was associated with 3.8 (95% CI 1.6, 6.0, P <0.001) more days in hospital.
  
  
  CONCLUSIONS
  Anastomosis time may be an underappreciated but modifiable variable in dictating use of hospital resources. The impact of anastomosis time on longer term outcomes deserves further study.
authors.affiliation: Department of Medicine, Dalhousie University, 5082 Dickson Building, Queen Elizabeth Health Sciences-VG site, 5280 University Ave, Halifax NS B3H 1V7, Canada. Bryce.kiberd@dal.ca.
authors.forename: Karim
authors.initials: K
authors.lastname: Marzouk
authors.forename: Joseph
authors.initials: J
authors.lastname: Lawen
authors.forename: Ian
authors.initials: I
authors.lastname: Alwayn
authors.forename: Bryce A
authors.initials: BA
authors.lastname: Kiberd