International Urology and Nephrology

, Volume 44, Issue 5, pp 1417–1423

Optimized outcomes for renal allografts with cold ischemic times of 20 h or greater

  • Anja Gallinat
  • Andreas Paul
  • Thomas Minor
  • Jürgen W. Treckmann
  • Ernesto P. Molmenti
  • Oliver Witzke
  • Georgios C. Sotiropoulos
Urology - Original Paper

DOI: 10.1007/s11255-012-0235-8

Cite this article as:
Gallinat, A., Paul, A., Minor, T. et al. Int Urol Nephrol (2012) 44: 1417. doi:10.1007/s11255-012-0235-8
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Abstract

Background

Prolonged cold ischemia time (CIT) has been associated with inferior graft survival in kidney transplantation (KT). The aim of this study was to evaluate the impact of prolonged CIT on short- and long-term outcomes and to determine the possible ways to optimize the use of these organs.

Methods

All kidney transplants from April 2001 to December 2010 with CIT ≥ 20 h were considered. Donor and recipient data were analyzed with uni- and multivariate Cox proportional hazard analyses. Graft and patient survival were calculated using the Kaplan–Meier method.

Results

One hundred and eighty-one patients were transplanted with 184 grafts. Median recipient age and waiting time on dialysis were 52.5 and 4.9 years, respectively. After a median follow-up of 4.9 years, 148 of 181 patients are alive, 143 of them with functioning grafts. One-, three, and five-year graft and patient survival rates were 90, 87, and 79 %, and 96, 91, and 85 %, respectively. Donor age (p < 0.0001), retransplantation (p = 0.0025), and induction therapy with interleukin-2 antagonists (p = 0.0487) were predictors of graft survival by univariate analysis. Donor age and retransplantation remained significant by multivariate analysis (p < 0.001 and p = 0.0046, respectively). Donor age (p = 0.0176) and creatinine level at 1-month post-KT (p = 0.0271) were predictors of patient survival by univariate analysis. Only donor age reached multivariate significance (p = 0.0464). The calculated donor age cut off was 60 years.

Conclusions

Satisfactory long-term kidney transplant outcomes in the setting of CIT ≥ 20 h can be achieved with grafts from donors <60 years in first-time recipients. Induction therapy should preferably be with an interleukin-2 antagonist.

Keywords

Cold ischemia time Delayed graft function Kidney allocation Expanded criteria donor Marginal donor Kidney transplantation 

Abbreviations

CIT

Cold ischemic time

CMV

Cytomegalovirus

CPR

Cardiopulmonary resuscitation

DGF

Delayed graft function

HTK

Histidine–Tryptophane–Ketoglutarate

ICU

Intensive care unit

IGF

Immediate graft function

KLF2

Krüppel–like factor 2

KT

Kidney transplantation

ROC

Receiver operating characteristic

UW

University of Wisconsin

Copyright information

© Springer Science+Business Media, B.V. 2012

Authors and Affiliations

  • Anja Gallinat
    • 1
  • Andreas Paul
    • 1
  • Thomas Minor
    • 3
  • Jürgen W. Treckmann
    • 1
  • Ernesto P. Molmenti
    • 4
  • Oliver Witzke
    • 2
  • Georgios C. Sotiropoulos
    • 1
  1. 1.Department of General, Visceral, and Transplantation SurgeryUniversity Hospital EssenEssenGermany
  2. 2.Department of NephrologyUniversity Hospital EssenEssenGermany
  3. 3.Division of Surgical Research, Clinic of SurgeryUniversity of BonnBonnGermany
  4. 4.Department of SurgeryNorth Shore University HospitalManhassetUSA

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