Affiliation:
1. Department of Surgery University at Buffalo Buffalo New York USA
2. Transplant and Kidney Care Regional Center of Excellence Erie County Medical Center Buffalo New York USA
3. Department of Epidemiology and Environmental Health University at Buffalo School of Public Health and Health Professions Buffalo New York USA
4. Faculty of Medicine and Medical Sciences University of Balamand El‐Koura Lebanon
5. Jacobs School of Medicine and Biomedical Sciences University at Buffalo Buffalo New York USA
Abstract
AbstractDonation after circulatory death (DCD) kidneys are exposed to warm ischemia, which, coupled with cold ischemia time (CIT) exacerbates delayed graft function (DGF) and is possibly associated with worse graft survival. To analyze the risk of CIT‐induced DGF on DCD kidney outcomes, we evaluated national data between 2008 and 2018 of adult kidney‐only recipients of paired DCD kidneys where one kidney recipient experienced DGF and the other did not. Of 5602 paired DCD kidney recipients, multivariate analysis between recipients with higher CIT relative to lower CIT showed that increasing CIT differences had a significant dose‐dependent effect on overall graft survival. The graft survival risk was minimal with CIT differences of ≥1‐h (adjusted hazard ratio [aHR] 1.07, 95% CI .95– 1.20, n = 5602) and ≥5‐h (aHR 1.09, 95% CI .93–1.29, n = 2710) and became significant at CIT differences of ≥10‐h (aHR 1.37, 95% CI 1.05–1.78, n = 1086) and ≥15‐h (aHR 1.78, 95% CI 1.15–2.77, n = 1086). Between each of the four delta‐CIT levels of shorter and longer CIT, there were no statistically significant differences in the proportion of acute rejection. These results suggest that in the setting of DCD kidney transplantation (KTX), DGF, specifically mediated by prolonged CIT, impacts long‐term graft outcomes.