Impact of Cold Ischemia Time and Donor Age on Donation After Circulatory Death Kidney Transplant Outcomes: A UNOS Mate-Kidney Analysis

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-12-05 DOI:10.1111/ctr.70051

Gabriel Cojuc-Konigsberg, Belen Rivera, Stalin Cañizares, Martha Pavlakis, Devin Eckhoff, Bhavna Chopra

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Abstract

Background

The association between prolonged cold ischemia times (CIT), donor age, and outcomes in kidney transplant recipients (KTRs) from donors after circulatory death (DCD) remains uncertain. We aimed to compare allograft outcomes in DCD-donor KTRs according to CIT and age.

Methods

UNOS database study (2010–2024) of DCD-donor KTRs on tacrolimus maintenance. We developed a mate-kidney analysis, comparing outcomes where one mate kidney had CIT >24 and the other ≤24 h. We evaluated patient death, all-cause allograft failure, and death-censored graft failure (DCGF) using multivariable stratified Cox proportional hazards models. We compared outcomes across age groups (≥50 or <50 years) and 6-h-period CIT deltas between mate kidneys. We assessed delayed graft function (DGF) occurrence with multivariable conditional logistic regression.

Results

We included 4092 DCD-donor mate-kidney pairs. There were no differences between CIT >24 versus ≤24 h in patient death (aHR 1.12, 95% CI 0.97–1.30), all-cause allograft failure (aHR 1.10, 95% CI 0.98–1.24), or DCGF (aHR 1.07, 95% CI 0.90–1.27). Similar results were observed when comparing outcomes by age group and 6-h-period CIT deltas between mate kidneys. Compared to shorter CITs, CITs >24 h were associated with increased DGF likelihood (aOR 1.42, 95% CI 1.25–1.60), as were increasing CIT deltas.

Conclusion

CITs >24 h in DCD-donor KTRs were not associated with adverse allograft outcomes, irrespective of age group. However, prolonged CITs were associated with increased DGF likelihood. Increasing the acceptance of both mate kidney from DCD donors should be considered despite projected CITs >24 h.

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冷缺血时间和供者年龄对循环死亡肾移植后捐献结果的影响：一项UNOS配对肾分析。

背景：供体肾移植受者循环性死亡（DCD）后延长冷缺血时间（CIT）、供体年龄与预后之间的关系尚不确定。我们的目的是根据CIT和年龄比较cd供体KTRs的同种异体移植结果。方法：UNOS数据库（2010-2024）研究cd -供体ktr对他克莫司维持的影响。我们进行了配对肾脏分析，比较了一个配对肾脏CIT为bbbb24和另一个≤24小时的结果。我们使用多变量分层Cox比例风险模型评估了患者死亡、全因同种异体移植失败和死亡审查移植失败（DCGF）。我们比较了不同年龄组（≥50岁）的结果。结果：我们纳入了4092对cd供体配对肾脏。在患者死亡（aHR 1.12, 95% CI 0.97-1.30）、全因同种异体移植失败（aHR 1.10, 95% CI 0.98-1.24）或DCGF （aHR 1.07, 95% CI 0.90-1.27）方面，CIT 24小时与≤24小时之间没有差异。当按年龄组和配偶肾脏之间的6 h期CIT delta比较结果时，观察到类似的结果。与较短的CIT相比，CIT bbb24 h与DGF可能性增加相关（aOR 1.42, 95% CI 1.25-1.60）， CIT δ增加也是如此。结论：无论年龄如何，cd供体KTRs的CITs bbb24 h与同种异体移植的不良结果无关。然而，延长的CITs与DGF的可能性增加有关。尽管预计CITs为24小时，但仍应考虑增加DCD供者的双配偶肾的接受度。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.