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

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

Research output: Contribution to journalArticle

8 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

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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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