title: The Impact of Total Ischemic Time, Donor Age and the Pathway of Donor Death on Graft Outcomes After Deceased Donor Kidney Transplantation.
abstract: Prolonged ischemia is a known risk factor for delayed graft function (DGF) and its interaction with donor characteristics, the pathways of donor death, and graft outcomes may have important implications for allocation policies.
  
  
  
  Using data from the Australian and New Zealand Dialysis and Transplant registry (1994-2013), we examined the relationship between total ischemic time with graft outcomes among recipients who received their first deceased donor kidney transplants. Total ischemic time (in hours) was defined as the time of the donor renal artery interruption or aortic clamp, until the time of release of the clamp on the renal artery in the recipient.
  
  
  
  A total of 7542 recipients were followed up over a median follow-up time of 5.3 years (interquartile range of 8.2 years). Of these, 1823 (24.6%) experienced DGF and 2553 (33.9%) experienced allograft loss. Recipients with total ischemic time of 14 hours or longer experienced an increased odd of DGF compared with those with total ischemic time less than 14 hours. This effect was most marked among those with older donors (P value for interaction = 0.01). There was a significant interaction between total ischemic time, donor age, and graft loss (P value for interaction = 0.03). There was on average, a 9% increase in the overall risk of graft loss per hour increase in the total ischemic time (adjusted hazard ratio, 1.09; 95% confidence interval, 1.01-1.18; P = 0.02) in recipients with older donation after circulatory death grafts.
  
  
  
  There is a clinically important interaction between donor age, the pathway of donor death, and total ischemic time on graft outcomes, such that the duration of ischemic time has the greatest impact on graft survival in recipients with older donation after circulatory death kidneys.
authors.affiliation: 1 Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia. 2 Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia. 3 University of Adelaide, Adelaide, Australia. 4 ANZDATA registry, Adelaide, SA, Australia. 5 Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.forename: Armando
authors.initials: A
authors.lastname: Teixeira-Pinto
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.forename: Henry
authors.initials: H
authors.lastname: Pleass
authors.forename: Stephen
authors.initials: S
authors.lastname: McDonald
authors.forename: Wai H
authors.initials: WH
authors.lastname: Lim
mesh_terms: D000328:Adult; D000367:Age Factors; D001315:Australia; D002423:Cause of Death; D050377:Cold Ischemia / Q000009:adverse effects; D051799:Delayed Graft Function / Q000209:etiology; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D061646:Operative Time; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D052096:Warm Ischemia / Q000009:adverse effects