title: The faster the better: anastomosis time influences patient survival after deceased donor kidney transplantation.
abstract: Despite a continuously growing knowledge of the impact of factors on kidney graft function, such as donor age, body mass index, and cold ischemia time, few data are available regarding anastomosis time (AT) and its impact on long-term results. We investigated whether surgical AT correlates with patient and graft survival after kidney transplantation performing a retrospective analysis of 1245 consecutive deceased donor kidney transplantations between 01/2000 and 12/2010 at Innsbruck Medical University. Kaplan-Meier and log-rank analyses were carried out for 1- and 5-year patient and graft survival. AT was defined as time from anastomosis start until reperfusion. Median AT was 30 min. Five-year survival of allografts with an AT >30 min was 76.6% compared with 80.6% in the group with AT <30 min (P = 0.027). Patient survival in the group with higher AT similarly was inferior with 85.7% after 5 years compared with 89.6% (P < 0.0001) [Correction added on February 18, 2015, after first online publication: the percentage value for patient survival was previously incorrect and have now been changed to 89.6%]. Cox regression analysis revealed AT as an independent significant factor for patient survival (HR 1.021 per minute; 95% CI 1.006-1.037; P = 0.006). As longer AT closely correlates with inferior long-term patient survival, it has to be considered as a major risk factor for inferior long-term results after deceased donor kidney transplantation.
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Weissenbacher
authors.forename: Rupert
authors.initials: R
authors.lastname: Oberhuber
authors.forename: Benno
authors.initials: B
authors.lastname: Cardini
authors.forename: Sascha
authors.initials: S
authors.lastname: Weiss
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
authors.forename: Claudia
authors.initials: C
authors.lastname: Bösmüller
authors.forename: Stefan
authors.initials: S
authors.lastname: Schneeberger
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
authors.forename: Robert
authors.initials: R
authors.lastname: Öllinger
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D015992:Body Mass Index; D050377:Cold Ischemia; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome
keywords: anastomosis time; deceased donor; graft survival; kidney transplantation; patient survival