title: Each additional hour of cold ischemia time significantly increases the risk of graft failure and mortality following renal transplantation.
abstract: Although cold ischemia time has been widely studied in renal transplantation area, there is no consensus on its precise relationship with the transplantation outcomes. To study this, we sampled data from 3839 adult recipients of a first heart-beating deceased donor kidney transplanted between 2000 and 2011 within the French observational multicentric prospective DIVAT cohort. A Cox model was used to assess the relationship between cold ischemia time and death-censored graft survival or patient survival by using piecewise log-linear function. There was a significant proportional increase in the risk of graft failure for each additional hour of cold ischemia time (hazard ratio, 1.013). As an example, a patient who received a kidney with a cold ischemia time of 30 h presented a risk of graft failure near 40% higher than a patient with a cold ischemia time of 6 h. Moreover, we found that the risk of death also proportionally increased for each additional hour of cold ischemia time (hazard ratio, 1.018). Thus, every additional hour of cold ischemia time must be taken into account in order to increase graft and patient survival. These findings are of practical clinical interest, as cold ischemia time is among one of the main modifiable pre-transplantation risk factors that can be minimized by improved management of the peri-transplantation period.
authors.affiliation: Institut de Transplantation Urologie Néphrologie, ITUN, CHU Nantes, RTRS « Centaure », Nantes and Inserm U1064, Labex Transplantex, University of Nantes, Nantes, France.
authors.forename: Agnes
authors.initials: A
authors.lastname: Debout
authors.affiliation: 1] Institut de Transplantation Urologie Néphrologie, ITUN, CHU Nantes, RTRS « Centaure », Nantes and Inserm U1064, Labex Transplantex, University of Nantes, Nantes, France [2] EA 4275 SPHERE-Biostatistics, Pharmacoepidemiology and Subjective Measures in Health Sciences, University of Nantes, Nantes, France.
authors.forename: Yohann
authors.initials: Y
authors.lastname: Foucher
authors.affiliation: 1] Institut de Transplantation Urologie Néphrologie, ITUN, CHU Nantes, RTRS « Centaure », Nantes and Inserm U1064, Labex Transplantex, University of Nantes, Nantes, France [2] EA 4275 SPHERE-Biostatistics, Pharmacoepidemiology and Subjective Measures in Health Sciences, University of Nantes, Nantes, France.
authors.forename: Katy
authors.initials: K
authors.lastname: Trébern-Launay
authors.affiliation: 1] Service de Transplantation Rénale et de Soins Intensifs, Hôpital Necker, APHP, Paris, France [2] University of Paris Descartes, University of Sorbonne Paris Cité, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Legendre
authors.affiliation: 1] Service de Transplantation Rénale et de Soins Intensifs, Hôpital Necker, APHP, Paris, France [2] University of Paris Descartes, University of Sorbonne Paris Cité, Paris, France.
authors.forename: Henri
authors.initials: H
authors.lastname: Kreis
authors.affiliation: Service de Néphrologie, Dialyse et Transplantation, Hôpital Lapeyronie, University of Montpellier, Montpellier, France.
authors.forename: Georges
authors.initials: G
authors.lastname: Mourad
authors.affiliation: Service de Néphrologie, Dialyse et Transplantation, Hôpital Lapeyronie, University of Montpellier, Montpellier, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Garrigue
authors.affiliation: Service de Néphrologie, Transplantation et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Morelon
authors.affiliation: Service de Néphrologie, Transplantation et Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France.
authors.forename: Fanny
authors.initials: F
authors.lastname: Buron
authors.affiliation: 1] Département de Néphrologie et de Transplantation d'Organes, CHU Rangueil, Toulouse, France [2] University Paul Sabatier Toulouse, Toulouse, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
authors.affiliation: 1] Département de Néphrologie et de Transplantation d'Organes, CHU Rangueil, Toulouse, France [2] University Paul Sabatier Toulouse, Toulouse, France.
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.affiliation: Service de Transplantation Rénale, CHU Brabois, Nancy, France.
authors.forename: Michèle
authors.initials: M
authors.lastname: Kessler
authors.affiliation: Service de Transplantation Rénale, CHU Brabois, Nancy, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Ladrière
authors.affiliation: Centre d'Investigation Clinique biothérapie, Nantes, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Poignas
authors.affiliation: EA 4275 SPHERE-Biostatistics, Pharmacoepidemiology and Subjective Measures in Health Sciences, University of Nantes, Nantes, France.
authors.forename: Amina
authors.initials: A
authors.lastname: Blidi
authors.affiliation: Institut de Transplantation Urologie Néphrologie, ITUN, CHU Nantes, RTRS « Centaure », Nantes and Inserm U1064, Labex Transplantex, University of Nantes, Nantes, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Soulillou
authors.affiliation: 1] Institut de Transplantation Urologie Néphrologie, ITUN, CHU Nantes, RTRS « Centaure », Nantes and Inserm U1064, Labex Transplantex, University of Nantes, Nantes, France [2] Centre d'Investigation Clinique biothérapie, Nantes, France.
authors.forename: Magali
authors.initials: M
authors.lastname: Giral
authors.affiliation: EA 4275 SPHERE-Biostatistics, Pharmacoepidemiology and Subjective Measures in Health Sciences, University of Nantes, Nantes, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Dantan
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D050377:Cold Ischemia / Q000009:adverse effects*; D005260:Female; D005602:France / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D017211:Treatment Failure