Prolonged Organ Extraction Time Negatively Impacts Kidney Transplantation Outcome

被引:2
|
作者
Maassen, Hanno [1 ,2 ]
Leuvenink, Henri G. D. [1 ]
van Goor, Harry [2 ]
Sanders, Jan-Stephan F. [3 ]
Pol, Robert A. [1 ]
Moers, Cyril [1 ]
Hofker, H. Sijbrand [1 ]
机构
[1] Univ Groningen, Univ Med Ctr Groningen, Dept Surg, Groningen, Netherlands
[2] Univ Groningen, Univ Med Ctr Groningen, Dept Pathol & Med Biol, Groningen, Netherlands
[3] Univ Groningen, Univ Med Ctr Groningen, Dept Nephrol, Groningen, Netherlands
关键词
extraction; time; nephrectomy; kidney; transplantation outcome; ISCHEMIA-REPERFUSION INJURY; DECEASED DONORS; COLD ISCHEMIA; RISK; STORAGE;
D O I
10.3389/ti.2021.10186
中图分类号
R61 [外科手术学];
学科分类号
摘要
Main Problem: Following cold aortic flush in a deceased organ donation procedure, kidneys never reach the intended 0-4 degrees C and stay ischemic at around 20 degrees C in the donor's body until actual surgical retrieval. Therefore, organ extraction time could have a detrimental influence on kidney transplant outcome.Materials and Methods: We analyzed the association between extraction time and kidney transplant outcome in multicenter data of 5,426 transplant procedures from the Dutch Organ Transplantation Registry (NOTR) and 15,849 transplant procedures from the United Network for Organ Sharing (UNOS).Results: Extraction time was grouped per 10-min increment. In the NOTR database, extraction time was independently associated with graft loss [HR 1.027 (1.004-1.050); p = 0.022] and with DGF [OR 1.043 (1.021-1.066); p < 0.005]. An extraction time >80 min was associated with a 27.4% higher hazard rate of graft failure [HR 1.274 (1.080-1.502); p = 0.004] and such kidneys had 43.8% higher odds of developing DGF [OR 1.438, (1.236-1.673); p < 0.005]. In the UNOS database, increasing extraction times in DCD donors were associated with DGF [OR 1.036 (1.016-1.055); p < 0.005]. An extraction time >30 min was associated with 14.5% higher odds of developing DGF [OR 1.145 (1.063-1.233); p < 0.005].Discussion: Prolonged kidney extraction time negatively influenced graft survival in Dutch donors and increased DGF risk in all deceased donor recipients.
引用
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页数:11
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