title: Effect of the Second Warm Ischemia Time and Its Components on Early and Long-term Kidney Graft Function.
abstract: BACKGROUND
  During kidney transplantation, the total time of organ ischemia consists of first warm ischemia time (WIT1), cold ischemia time (CIT), and a second WIT (WIT2). Rising graft temperature during WIT2, which comprises the creation of vascular anastomoses, increases oxygen demand and tissue damage, especially in the kidney tubular cells. The aim of this study was to analyze the influence of WIT2 on early and long-term kidney graft function.
  
  
  METHODS
  We performed a retrospective analysis of 554 consecutive adult recipients, who received their first kidney graft from a deceased donor between 2003 and 2013.
  
  
  RESULTS
  Mean WIT2 was 25.2 min. Donors' sex, age, presence of hypertension, body mass index (BMI), and the cause of brain death showed no effect on WIT2. Weak positive correlations were found between the duration of WIT2 and both recipients' age (r = 0.11; P < .01) and BMI (r = 0.14; P < .01). Multivariate regression analysis confirmed the independent influence of age (β = 0.107 [95% confidence interval, 0.017 to 0.197] per year; P = .02) but not BMI (P = .09). WIT2 influenced early graft function and was significantly longer in patients with primary graft nonfunction than in other recipients (35.3 vs 24.9 min; P < .01). According to receiver-operating characteristic curve analysis, a WIT2 value >26 min was predictive of primary graft nonfunction, with 64% specificity and 58% sensitivity. No correlations were found between WIT2 and estimated glomerular filtration rate in the long-term follow-up period.
  
  
  CONCLUSIONS
  This study found that WIT2 may significantly influence the early graft function. We also found that the creation time of vascular anastomoses does not affect the long-term kidney graft excretory function.
authors: Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Francuska, Poland.
authors: U
authors: U
authors: Kukla
authors: Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Francuska, Poland.
authors: H
authors: H
authors: Cholewa
authors: Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Francuska, Poland.
authors: J
authors: J
authors: Chronowska
authors: Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Francuska, Poland.
authors: T
authors: T
authors: Goc
authors: Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Francuska, Poland.
authors: E
authors: E
authors: Lieber
authors: Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Francuska, Poland. Electronic address: uryniusz@wp.pl.
authors: A
authors: A
authors: Kolonko
authors: Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Francuska, Poland.
authors: G
authors: G
authors: Budziński
authors: Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Francuska, Poland.
authors: J
authors: J
authors: Ziaja
authors: Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Francuska, Poland.
authors: A
authors: A
authors: Więcek
authors: Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Francuska, Poland.
authors: L
authors: L
authors: Cierpka
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D050377:Cold Ischemia / Q000706:statistics & numerical data*; D051799:Delayed Graft Function / Q000453:epidemiology*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D016896:Treatment Outcome; D052096:Warm Ischemia / Q000706:statistics & numerical data*; D055815:Young Adult