PMID- 14717946
OWN - NLM
STAT- MEDLINE
DCOM- 20040914
LR  - 20081121
IS  - 0085-2538 (Print)
IS  - 0085-2538 (Linking)
VI  - 65
IP  - 2
DP  - 2004 Feb
TI  - Cold ischemia and the reduced long-term survival of cadaveric renal allografts.
PG  - 713-8
AB  - BACKGROUND: Prolonged cold ischemia time (CIT) is accompanied by delayed 
      cadaveric renal allograft function and early allograft loss, but the effect of 
      CIT on long-term allograft survival is less certain and has not been studied in 
      detail. METHODS: Using data from the United Network for Organ Sharing, we 
      identified 6465 patients who received a kidney-only transplant of cadaveric 
      origin for the first time in 1995. We examined the effect of CIT on the 6-year 
      survival of these kidneys using Cox proportional hazard analysis. RESULTS: The 
      mean CIT of the kidney was 21 +/- 7 hours (mean +/- SD) and correlated with the 
      serum creatinine on discharge (R= 0.20, P < 0.001) and the distance traveled by 
      the kidneys (R= 0.30, P < 0.001). CIT had a significant effect on the 6-year 
      allograft survival (a 10-hour increase in CIT was associated with a hazard risk 
      ratio (RR) of 1.20 for graft failure (P < 0.001) that persisted (RR = 1.40, P= 
      0.021) after adjusting for donor age, recipient age and race, human leukocyte 
      antigen (HLA) mismatch, panel reactive antibodies, and first 6 months' rejection 
      treatments. Similarly, compared to CIT category of 0 to 10 hours, the 6-year 
      graft survival was progressively worse for 11 to 20 hours (RR = 1.03), 21 to 30 
      hours (RR = 1.12), and, significantly so, for >30 hours (RR = 1.32; P= 0.011). 
      The gain in HLA match with increasing CIT was not uniform; for instance, HLA 
      match in >30 hours was lower than for 21 to 30 hours (2.4 +/- 1.5 vs. 2.7 +/- 
      1.6; P < 0.001). CONCLUSION: (1) Cadaveric kidneys continue to undergo prolonged 
      periods of cold ischemia; (2) prolonged cold storage is associated with longer 
      distance traveled by the kidneys, but is not associated with any significant gain 
      in tissue matching; and (3) prolonged cold ischemia is a significant predictor of 
      long-term graft loss. Reducing prolonged cold ischemia by regional distribution 
      of organs and less stringent tissue matching may reduce the persistent high rate 
      of long-term loss of cadaveric renal allografts.
FAU - Salahudeen, Abdulla K
AU  - Salahudeen AK
AD  - Department of Medicine, University of Mississippi Medical Center, Jackson, 
      Mississippi 39216, USA. Asalahudeen@medicine.umsmed.edu
FAU - Haider, Naeem
AU  - Haider N
FAU - May, Warren
AU  - May W
LA  - eng
GR  - R0-1 DK-56835-01/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Kidney Int
JT  - Kidney international
JID - 0323470
SB  - IM
MH  - Adult
MH  - Cadaver
MH  - *Cold Temperature
MH  - Databases, Factual
MH  - Female
MH  - *Graft Survival
MH  - Humans
MH  - Ischemia/*physiopathology
MH  - Kidney/*physiology
MH  - Kidney Transplantation/*statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Time Factors
MH  - Transplantation, Homologous
MH  - Transportation
EDAT- 2004/01/14 05:00
MHDA- 2004/09/15 05:00
CRDT- 2004/01/14 05:00
PHST- 2004/01/14 05:00 [pubmed]
PHST- 2004/09/15 05:00 [medline]
PHST- 2004/01/14 05:00 [entrez]
AID - S0085-2538(15)49758-3 [pii]
AID - 10.1111/j.1523-1755.2004.00416.x [doi]
PST - ppublish
SO  - Kidney Int. 2004 Feb;65(2):713-8. doi: 10.1111/j.1523-1755.2004.00416.x.