title: Pulsatile perfusion reduces the risk of delayed graft function in deceased donor kidney transplants, irrespective of donor type and cold ischemic time.
abstract: BACKGROUND
  The role of pulsatile perfusion (PP) across different cold ischemic times (CIT) within different donor groups is unclear. This study examined the association of PP with delayed graft function (DGF) in all (n=94,709) deceased donor kidney transplants in the US between 2000 and 2011, as a function of CIT and donor type.
  
  
  METHODS
  Using the Scientific Registry of Transplant Recipients data, all adult standard criteria donors (SCD, n=71,192), expanded criteria donors (ECD, n=15,122), and donors after circulatory death (DCD, n=8,395) kidney transplant recipients were identified. Within each donor group, transplants were stratified based on duration of CIT: 0 to 6 hours, 6.1 to 12 hours, 12.1 to 18 hours, 18.1 to 24 hours, 24.1 to 30 hours, 30.1 to 36 hours, and greater than 36 hours. Within each group, the odds of DGF with and without PP was determined after adjusting for donor, recipient, and transplant factors, including a propensity score for the likelihood of PP use, and clustering on transplant center using multivariable logistic regression.
  
  
  RESULTS
  When stratified by donor type and CIT, the adjusted odds of DGF were lower with PP across all CIT in SCD transplants, when CIT was greater than 6 hours in ECD transplants, and when CIT was between 6 and 24 hours in DCD transplants. CIT was independently associated with a greater risk of DGF irrespective of storage method, but this effect was substantially modified by PP.
  
  
  CONCLUSIONS
  PP is associated with a reduced risk of DGF irrespective of donor type and CIT. Although PP modifies the impact of CIT on the risk of DGF, it does not eliminate its association with DGF, suggesting the optimal strategy to reduce DGF is to minimize CIT and utilize PP in all deceased donor transplants.
authors.affiliation: 1 Division of Nephrology, University of British Columbia, Vancouver, Canada. 2 Center for Health Evaluation and Outcomes Sciences, Vancouver, Canada. 3 Department of Urologic Sciences, University of British Columbia, Vancouver, Canada. 4 Tufts-New England Medical Center, Boston, MA. 5 Address correspondence to: Jagbir Gill, M.D., M.P.H., University of British Columbia, St. Paul's Hospital, Providence Building Ward 6a-1081 Burrard Street, Vancouver, BC, Canada V6Z 1YK.
authors.forename: Jagbir
authors.initials: J
authors.lastname: Gill
authors.forename: James
authors.initials: J
authors.lastname: Dong
authors.forename: Michael
authors.initials: M
authors.lastname: Eng
authors.forename: David
authors.initials: D
authors.lastname: Landsberg
authors.forename: John S
authors.initials: JS
authors.lastname: Gill
mesh_terms: D016000:Cluster Analysis; D050377:Cold Ischemia / Q000009:adverse effects*; D051799:Delayed Graft Function / Q000209:etiology*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010477:Perfusion / Q000009:adverse effects* / Q000379:methods; D057216:Propensity Score; D011673:Pulsatile Flow; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome