title: Reduction of Cold Ischemia Time and Anastomosis Time Correlates with Lower Delayed Graft Function Rates Following Transplantation of Marginal Kidneys.
abstract: BACKGROUND In kidney transplantation, the association of cold ischemia time (CIT), anastomosis time (AT), and delayed graft function (DGF) is particularly detrimental in grafts from marginal donors; however, actual cut-off criteria are still debated. MATERIAL AND METHODS Data from patients >65 years (n=193) and patients <65 years (n=1054) transplanted between 2000 and 2010 were retrospectively analyzed regarding the age-dependent impact of ischemia times and DGF. RESULTS Overall death censored graft survival was inferior for ECD/DCD organs. Graft survival was significantly impaired by DGF in younger and older recipients. The multivariate analysis revealed an age-dependent profile of risk factors for DGF. In younger patients, multiple risk factors were identified while in patients >65 years, only CIT and AT were correlated with DGF. Marginal grafts with a CIT<769 min had a comparable outcome to any SCD organ; extended CIT >770 min worsened ECD/DCD survival significantly. Similarly, AT longer than 26 min was associated with a significantly impaired survival of ECD/DCD grafts. In a Cox regression analysis with penalized splines, this increased risk of graft loss was not linear: CIT beyond 800 min and AT beyond 20 min were cut-off values associated with worse outcomes in marginal organs. CONCLUSIONS Thus, risk factors for DGF are age-dependent; keeping ischemia times below these thresholds offers outcome of ECD/DCD organs comparable to SCD organs.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charite Universitätsmedizin, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Denecke
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charite Universitätsmedizin, Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Biebl
authors.affiliation: Department for Medical Statistics, Informatics and Health Economics, Medical University, Innsbruck, Austria.
authors.forename: Josef
authors.initials: J
authors.lastname: Fritz
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charite Virchow Clinic, Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Brandl
authors.affiliation: Department of General, Visceral, Vascular and Thoracic Surgery, Charite Universitätsmedizin, Berlin, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Weiss
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charite Virchow Clinic, Berlin, Germany.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Dziodzio
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charite Virchow Clinic, Berlin, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Aigner
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charite Virchow Clinic, Berlin, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Sucher
authors.affiliation: Department of Visceral, Transplantation and Thoracic Surgery, Medical University, Innsbruck, Austria.
authors.forename: Claudia
authors.initials: C
authors.lastname: Bösmüller
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charite Virchow Clinic, Berlin, Germany.
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charite Virchow Clinic, Berlin, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Öllinger
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D050377:Cold Ischemia / Q000009:adverse effects*; D051799:Delayed Graft Function / Q000209:etiology*; D005260:Female; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome