title: [Cold ischemia and renal graft survival: A paired analysis comparing first and second grafts from the same donor].
abstract: OBJECTIVE
  To compare the characteristics, clinical course, and survival of pairs of renal grafts from the same donor, with special interest in cold ischemia times (CIT) as a risk factor for graft survival.
  
  
  METHODS
  We retrospectively reviewed paired grafts originating from the same cadaver donor from our prospectively recorded database of kidney transplants, from 1987 to 2015. We selected and divided them into two groups depending on whether they corresponded to the first or second graft.
  
  
  RESULTS
  We studied a total of 860 paired kidneys. Mean CIT for the first and second groups were 15.12 and 19.16 hours, respectively. In the second group we observed higher incidences of acute tubular necrosis and initial delayed graft function (59.9% vs. 69.4% and 54.9% vs. 63.5%, respectively; p<0.001). No significant differences in either creatinine clearance rate or the rate of dialysis were observed between the two groups. No difference was found between the first and second groups in terms of graft survival (18.4 vs. 18.1 years, respectively; log-rank, p=0.667), and no differences were found by dividing the grafts into different categories according to their CIT (<14, 14-17, 17-20, >20 hours). For the set of grafts studied, CIT did not act as a risk factor for graft survival (hazard ratio [HR]=1.014; p=0.312).
  
  
  CONCLUSIONS
  The proportion of ATN and DGF were greater in second transplants. However, there were no differences in long-term graft survival. Furthermore, we found no evidence that a CIT for less than 24 hours acted as a risk factor to graft survival.
authors.affiliation: Instituto de Investigación Biosanitaria ibs. Granada. Services of Urology. Granada. Andalucia. Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Puche-Sanz
authors.affiliation: Instituto de Investigación Biosanitaria ibs. Granada. Services of Urology. Granada. Andalucia. Spain.
authors.forename: José Francisco
authors.initials: JF
authors.lastname: Flores-Martín
authors.affiliation: Instituto de Investigación Biosanitaria ibs. Granada. Services of Urology. Granada. Andalucia. Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Vázquez-Alonso
authors.affiliation: Instituto de Investigación Biosanitaria ibs. Granada. Fundación FIBAO-Complejo Hospitalario Universitario Granada (CHUG). Universidad de Granada.
authors.forename: Manuela
authors.initials: M
authors.lastname: Expósito-Ruiz
authors.affiliation: Instituto de Investigación Biosanitaria ibs. Granada. Services of Nephrology. Granada. Andalucia. Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Bravo-Soto
authors.affiliation: Instituto de Investigación Biosanitaria ibs. Granada. Services of Urology. Granada. Andalucia. Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Vicente-Prados
authors.affiliation: Instituto de Investigación Biosanitaria ibs. Granada. Services of Urology. Granada. Andalucia. Spain.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Cózar-Olmo
mesh_terms: D050377:Cold Ischemia; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors