Negative impact of prolonged cold storage time before machine perfusion preservation in donation after circulatory death kidney transplantation

Siegfredo Paloyo, Junichiro Sageshima, Jeffrey J. Gaynor, Linda Chen, Gaetano Ciancio, George W. Burke

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Kidney grafts are often preserved initially in static cold storage (CS) and subsequently on hypothermic machine perfusion (MP). However, the impact of CS/MP time on transplant outcome remains unclear. We evaluated the effect of prolonged CS/MP time in a single-center retrospective cohort of 59 donation after circulatory death (DCD) and 177 matched donation after brain death (DBD) kidney-alone transplant recipients. With mean overall CS/MP times of 6.0 h/30.0 h, overall incidence of delayed graft function (DGF) was higher in DCD transplants (30.5%) than DBD transplants (7.3%, P < 0.0001). In logistic regression, DCD recipient (P < 0.0001), longer CS time (P = 0.0002), male recipient (P = 0.02), and longer MP time (P = 0.08) were associated with higher DGF incidence. In evaluating the joint effects of donor type (DBD vs. DCD), CS time (<6 vs. ≥6 h), and MP time (<36 vs. ≥36 h) on DGF incidence, one clearly sees an unfavorable effect of MP time ≥36 h (P = 0.003) across each donor type and CS time stratum, whereas the unfavorable effect of CS time ≥6 h (P = 0.01) is primarily seen among DCD recipients. Prolonged cold ischemia time had no unfavorable effect on renal function or graft survival at 12mo post-transplant. Long CS/MP time detrimentally affects early DCD/DBD kidney transplant outcome when grafts were mainly preserved by MP; prolonged CS time before MP has a particularly negative impact in DCD kidney transplantation.

Original languageEnglish (US)
Pages (from-to)1117-1125
Number of pages9
JournalTransplant International
Volume29
Issue number10
DOIs
StatePublished - Oct 1 2016

Keywords

  • deceased donor kidney transplantation
  • donation after cardiac death
  • hypothermic machine perfusion
  • ischemia reperfusion injury
  • organ preservation

ASJC Scopus subject areas

  • Transplantation

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