title: Negative impact of prolonged cold storage time before machine perfusion preservation in donation after circulatory death kidney transplantation.
abstract: Kidney grafts are often preserved initially in static cold storage (CS) and subsequently on hypothermic machine perfusion (MP). However, the impact of CS/MP time on transplant outcome remains unclear. We evaluated the effect of prolonged CS/MP time in a single-center retrospective cohort of 59 donation after circulatory death (DCD) and 177 matched donation after brain death (DBD) kidney-alone transplant recipients. With mean overall CS/MP times of 6.0 h/30.0 h, overall incidence of delayed graft function (DGF) was higher in DCD transplants (30.5%) than DBD transplants (7.3%, P < 0.0001). In logistic regression, DCD recipient (P < 0.0001), longer CS time (P = 0.0002), male recipient (P = 0.02), and longer MP time (P = 0.08) were associated with higher DGF incidence. In evaluating the joint effects of donor type (DBD vs. DCD), CS time (<6 vs. ≥6 h), and MP time (<36 vs. ≥36 h) on DGF incidence, one clearly sees an unfavorable effect of MP time ≥36 h (P = 0.003) across each donor type and CS time stratum, whereas the unfavorable effect of CS time ≥6 h (P = 0.01) is primarily seen among DCD recipients. Prolonged cold ischemia time had no unfavorable effect on renal function or graft survival at 12mo post-transplant. Long CS/MP time detrimentally affects early DCD/DBD kidney transplant outcome when grafts were mainly preserved by MP; prolonged CS time before MP has a particularly negative impact in DCD kidney transplantation.
authors.affiliation: Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute, Miami, FL, USA.
authors.forename: Siegfredo
authors.initials: S
authors.lastname: Paloyo
authors.affiliation: Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute, Miami, FL, USA. jsageshima@ucdavis.edu.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Sageshima
authors.affiliation: Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute, Miami, FL, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Gaynor
authors.affiliation: Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute, Miami, FL, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute, Miami, FL, USA.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Ciancio
authors.affiliation: Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute, Miami, FL, USA.
authors.forename: George W
authors.initials: GW
authors.lastname: Burke
mesh_terms: D000328:Adult; D003080:Cold Temperature; D015925:Cryopreservation; D051799:Delayed Graft Function; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007165:Immunosuppression Therapy; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D013997:Time Factors
keywords: deceased donor kidney transplantation; donation after cardiac death; hypothermic machine perfusion; ischemia reperfusion injury; organ preservation