title: Prolonged Ischemic Time, Delayed Graft Function, and Graft and Patient Outcomes in Live Donor Kidney Transplant Recipients.
abstract: The association between prolonged cold ischemic time (CIT) and graft and patient outcomes in live donor kidney transplant recipients remains unclear. The aims of this study were to examine the association of CIT with delayed graft function and graft loss in live donor kidney transplant recipients and those who participated in the Australian Paired Kidney Exchange program using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry. Of 3717 live donor transplant recipients between 1997 and 2012 who were followed for a median of 6.6 years (25 977 person-years), 224 (25%) experienced CIT >4-8 h. Donor age was an effect modifier between CIT and graft outcomes. In recipients who received kidneys from older donors aged >50 years, every hour of increase in CIT was associated with adjusted odds of 1.28 (95% confidence interval [CI] 1.07-1.53, p = 0.007) for delayed graft function, whereas CIT >4-8 h was associated with adjusted hazards of 1.93 (95% CI 1.21-3.09, p = 0.006) and 1.91 (95% CI 1.05-3.49, p = 0.035) for overall and death-censored graft loss, respectively, compared with CIT of 1-2 h. Attempts to reduce CIT in live donor kidney transplants involving older donor kidneys may lead to improvement of graft outcomes.
authors.affiliation: Department of Renal Medicine, Sir Charles Gairdner Hospital, Western Australia, Australia.
authors.forename: A R
authors.initials: AR
authors.lastname: Krishnan
authors.affiliation: Australia and New Zealand Dialysis and Transplant Registry, South Australia, Australia.|Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia.|Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales, Australia.|Sydney School of Public Health, University of Sydney, New South Wales, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Wong
authors.affiliation: Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia.
authors.forename: J R
authors.initials: JR
authors.lastname: Chapman
authors.affiliation: Central and Northern Adelaide Renal and Transplantation Services, South Australia, Australia.
authors.forename: P T
authors.initials: PT
authors.lastname: Coates
authors.affiliation: Australia and New Zealand Dialysis and Transplant Registry, South Australia, Australia.|Central and Northern Adelaide Renal and Transplantation Services, South Australia, Australia.
authors.forename: G R
authors.initials: GR
authors.lastname: Russ
authors.affiliation: Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Pleass
authors.affiliation: Central and Northern Adelaide Renal and Transplantation Services, South Australia, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Russell
authors.affiliation: Department of Renal Medicine, Sir Charles Gairdner Hospital, Western Australia, Australia.
authors.forename: B
authors.initials: B
authors.lastname: He
authors.affiliation: Department of Renal Medicine, Sir Charles Gairdner Hospital, Western Australia, Australia.|Australia and New Zealand Dialysis and Transplant Registry, South Australia, Australia.
authors.forename: W H
authors.initials: WH
authors.lastname: Lim
mesh_terms: D000328:Adult; D050377:Cold Ischemia / Q000009:adverse effects*; D051799:Delayed Graft Function / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011379:Prognosis; D012042:Registries; D012307:Risk Factors
keywords: clinical research/practice; delayed graft function (DGF); graft survival; health services and outcomes research; infection and infectious agents; kidney (allograft) function/dysfunction; kidney transplantation/nephrology; kidney transplantation: living donor