The Impact of Anastomosis Time During Kidney Transplantation on Graft Loss: A Eurotransplant Cohort Study.
Recent studies raised the concern that warm ischemia during completion of vascular anastomoses in kidney implantation harms the transplant, but its precise impact on outcome and its interaction with other risk factors remain to be established. We investigated the relationship between anastomosis time and graft survival at 5 years after transplantation in 13 964 recipients of deceased donor solitary kidney transplants in the Eurotransplant region. Anastomosis time was independently associated with graft loss after adjusting for other risk factors (adjusted hazard ratio [HR] 1.10 for every 10-min increase, 95% confidence interval [CI] 1.06-1.14; p < 0.0001), whereas it did not influence recipient survival (HR 1.00, 95% CI 0.97-1.02). Kidneys from donation after circulatory death (DCD) were less tolerant of prolonged anastomosis time than kidneys from donation after brain death (p = 0.02 for interaction). The additive effect of anastomosis time with donor warm ischemia time (WIT) explains this observation because DCD status was no longer associated with graft survival when adjusted for this summed WIT, and there was no interaction between DCD status and summed WIT. Time to create the vascular anastomoses in kidney transplantation is associated with inferior transplant outcome, especially in recipients of DCD kidneys.
Department of Nephrology and Kidney Transplantation, University Hospitals Leuven, Leuven, Belgium.|Laboratory of Nephrology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
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0000-0002-4595-0195
L
Heylen
Department of Abdominal Transplantation Surgery, University Hospitals Leuven, Leuven, Belgium.|Laboratory of Abdominal Transplant Surgery, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
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J
Pirenne
Eurotransplant International Foundation, Leiden, the Netherlands.
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U
Samuel
Eurotransplant International Foundation, Leiden, the Netherlands.
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I
Tieken
Department of Nephrology and Kidney Transplantation, University Hospitals Leuven, Leuven, Belgium.|Laboratory of Nephrology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
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M
Naesens
Department of Nephrology and Kidney Transplantation, University Hospitals Leuven, Leuven, Belgium.|Laboratory of Nephrology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
B
B
Sprangers
Department of Abdominal Transplantation Surgery, University Hospitals Leuven, Leuven, Belgium.|Laboratory of Abdominal Transplant Surgery, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
I
I
Jochmans
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D001926:Brain Death; D015331:Cohort Studies; D046148:Donor Selection; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000592:standards*; D052096:Warm Ischemia / Q000009:adverse effects*
clinical research/practice; donors and donation: donation after brain death (DBD); donors and donation: donation after circulatory death (DCD); graft survival; ischemia reperfusion injury (IRI); kidney transplantation/nephrology