Impact of Warm Ischemia Time on Donation After Circulatory Death Kidney Transplant Outcomes

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-08-19 DOI:10.1111/ctr.15436

Karima Alghannam, Jeffrey Fine, Brian Howard, Jennifer Loza, Naeem M. Goussous, Junichiro Sageshima, Neal M. Mineyev, Aileen X. Wang, Richard V. Perez, Peter A. Than

{"title":"Impact of Warm Ischemia Time on Donation After Circulatory Death Kidney Transplant Outcomes","authors":"Karima Alghannam, Jeffrey Fine, Brian Howard, Jennifer Loza, Naeem M. Goussous, Junichiro Sageshima, Neal M. Mineyev, Aileen X. Wang, Richard V. Perez, Peter A. Than","doi":"10.1111/ctr.15436","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Efforts to address the shortage of donor organs include increasing the use of renal allografts from donors after circulatory death (DCD). While warm ischemia time (WIT) is thought to be an important factor in DCD kidney evaluation, few studies have compared the relationship between WIT and DCD kidney outcomes, and WIT acceptance practices remain variable.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We conducted a single-center retrospective review of all adult patients who underwent deceased donor kidney transplantation from 2000 to 2021. We evaluated the impact of varied functional warm ischemia time (fWIT) in controlled DCD donors by comparing donor and recipient characteristics and posttransplant outcomes between high fWIT (>60 min), low fWIT (≤60 min), and kidneys transplanted from donors after brain death (DBD).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Two thousand eight hundred eleven patients were identified, 638 received low fWIT DCD, 93 received high fWIT DCD, and 2080 received DBD kidneys. There was no significant difference in 5-year graft survival between the DCD low fWIT, high fWIT, and DBD groups, with 84%, 83%, and 83% of grafts functioning, respectively. Five-year patient survival was 91% in the low fWIT group, 92% in the high fWIT group, and 90% in the DBD group. An increase in kidney donor risk index (KDRI) (HR 3.37, 95% CI = 2.1–5.7) and high CIT compared to low CIT (HR 2.12, 95% CI = 1.4–3.1) have higher hazard ratios for 1-year graft failure.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Increased acceptance of kidneys from selected DCD donors with prolonged fWIT may present an opportunity to increase kidney utilization while preserving outcomes. Our group specifically prioritizes the use of kidneys from younger donors, with lower KDPI, and without acute kidney injury, or risk factors for underlying chronic kidney disease.</p>\n </section>\n </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.15436","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Transplantation","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ctr.15436","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Efforts to address the shortage of donor organs include increasing the use of renal allografts from donors after circulatory death (DCD). While warm ischemia time (WIT) is thought to be an important factor in DCD kidney evaluation, few studies have compared the relationship between WIT and DCD kidney outcomes, and WIT acceptance practices remain variable.

Methods

We conducted a single-center retrospective review of all adult patients who underwent deceased donor kidney transplantation from 2000 to 2021. We evaluated the impact of varied functional warm ischemia time (fWIT) in controlled DCD donors by comparing donor and recipient characteristics and posttransplant outcomes between high fWIT (>60 min), low fWIT (≤60 min), and kidneys transplanted from donors after brain death (DBD).

Results

Two thousand eight hundred eleven patients were identified, 638 received low fWIT DCD, 93 received high fWIT DCD, and 2080 received DBD kidneys. There was no significant difference in 5-year graft survival between the DCD low fWIT, high fWIT, and DBD groups, with 84%, 83%, and 83% of grafts functioning, respectively. Five-year patient survival was 91% in the low fWIT group, 92% in the high fWIT group, and 90% in the DBD group. An increase in kidney donor risk index (KDRI) (HR 3.37, 95% CI = 2.1–5.7) and high CIT compared to low CIT (HR 2.12, 95% CI = 1.4–3.1) have higher hazard ratios for 1-year graft failure.

Conclusions

Increased acceptance of kidneys from selected DCD donors with prolonged fWIT may present an opportunity to increase kidney utilization while preserving outcomes. Our group specifically prioritizes the use of kidneys from younger donors, with lower KDPI, and without acute kidney injury, or risk factors for underlying chronic kidney disease.

Abstract Image

查看原文本刊更多论文

热缺血时间对循环死亡后肾移植结果的影响

背景：解决供体器官短缺问题的努力包括增加使用循环死亡（DCD）后供体的肾脏异体移植。虽然温缺血时间（WIT）被认为是评估 DCD 肾脏的一个重要因素，但很少有研究对 WIT 与 DCD 肾脏结果之间的关系进行比较，而且接受 WIT 的方法仍不尽相同：我们对 2000 年至 2021 年期间接受过已故供体肾移植的所有成年患者进行了单中心回顾性研究。我们通过比较高fWIT（>60分钟）、低fWIT（≤60分钟）和脑死亡（DBD）后捐献者移植的肾脏之间的捐献者和受者特征及移植后结果，评估了不同功能性温缺血时间（fWIT）对受控DCD捐献者的影响：结果：共确定了 2811 名患者，其中 638 人接受了低 fWIT DCD 肾移植，93 人接受了高 fWIT DCD 肾移植，2080 人接受了 DBD 肾移植。低fWIT DCD组、高fWIT组和DBD组的5年移植物存活率没有明显差异，分别为84%、83%和83%。低fWIT组患者的5年存活率为91%，高fWIT组为92%，DBD组为90%。肾脏捐献者风险指数（KDRI）的增加（HR 3.37，95% CI = 2.1-5.7）和高CIT与低CIT相比（HR 2.12，95% CI = 1.4-3.1），1年移植物失败的危险比更高：结论：更多地接受肾功能不全捐献者的肾脏可能是提高肾脏利用率的一个机会，同时又能保护肾脏的预后。我们小组特别优先考虑使用年轻、KDPI 较低、无急性肾损伤或潜在慢性肾病风险因素的供体的肾脏。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.