The effect of anastomosis time on outcome in recipients of kidneys donated after brain death: a cohort study.
Whether warm ischemia during the time to complete the vascular anastomoses determines renal allograft function has not been investigated systematically. We investigated the effect of anastomosis time on allograft outcome in 669 first, single kidney transplantations from brain-dead donors. Anastomosis time independently increased the risk of delayed graft function (odds ratio per minute [OR] 1.05, 95% confidence interval [CI] 1.02-1.07, p < 0.001) and independently impaired allograft function after transplantation (p = 0.009, mixed-models repeated-measures analysis). In a subgroup of transplant recipients, protocol-specified biopsies at 3 months (n = 186), 1 year (n = 189), and 2 years (n = 153) were blindly reviewed. Prolonged anastomosis time independently increased the risk of interstitial fibrosis and tubular atrophy on these protocol-specified biopsies posttransplant (p < 0.001, generalized linear models). In conclusion, prolonged anastomosis time is not only detrimental for renal allograft outcome immediately after transplantation, also longer-term allograft function and histology are affected by the duration of this warm ischemia.
Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.|Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium.
L
L
Heylen
Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.|Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium.
M
M
Naesens
Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.|Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium.
I
I
Jochmans
Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.|Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium.
D
D
Monbaliu
Department of Pathology, University Hospitals Leuven, Leuven, Belgium.|Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
E
E
Lerut
Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.|Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium.
K
K
Claes
Department of Radiology, University Hospitals Leuven, Leuven, Belgium.|Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
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S
Heye
Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.|Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
P
P
Verhamme
Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.|Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium.
W
W
Coosemans
Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.|Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium.
B
B
Bammens
Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.|Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium.
P
P
Evenepoel
Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.|Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium.
B
B
Meijers
Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.|Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium.
D
D
Kuypers
Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.|Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium.
B
B
Sprangers
Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.|Department of Immunology and Microbiology, KU Leuven, Leuven, Belgium.
J
J
Pirenne
D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D001530:Belgium; D001926:Brain Death; D015331:Cohort Studies; D051799:Delayed Graft Function / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D005355:Fibrosis / Q000209:etiology / Q000473:pathology; D006084:Graft Rejection / Q000401:mortality / Q000473:pathology*; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D007683:Kidney Tubular Necrosis, Acute / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000379:methods; D061646:Operative Time; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014019:Tissue Donors; D066027:Transplant Recipients / Q000706:statistics & numerical data; D014184:Transplantation, Homologous; D016896:Treatment Outcome
DGF; allograft function; interstitial fibrosis; ischemia; kidney transplantation