Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Hufelandstraße 55, 45122 Essen, Germany.
Int Urol Nephrol. 2012 Oct;44(5):1417-23. doi: 10.1007/s11255-012-0235-8. Epub 2012 Jul 1.
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.
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.
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.
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.
在肾移植（KT）中，长时间的冷缺血时间（CIT）与移植物存活率降低有关。本研究旨在评估长时间 CIT 对短期和长期结果的影响，并确定优化这些器官使用的可能方法。
纳入 2001 年 4 月至 2010 年 12 月 CIT≥20 小时的所有肾移植患者。采用单变量和多变量 Cox 比例风险分析对供体和受体数据进行分析。使用 Kaplan-Meier 方法计算移植物和患者的存活率。
181 例患者接受了 184 个移植物。中位受体年龄和透析等待时间分别为 52.5 岁和 4.9 年。中位随访 4.9 年后，181 例患者中有 148 例存活，其中 143 例有功能移植物。1、3 和 5 年的移植物和患者存活率分别为 90%、87%和 79%，96%、91%和 85%。单变量分析显示，供体年龄（p<0.0001）、再次移植（p=0.0025）和白细胞介素-2 拮抗剂诱导治疗（p=0.0487）是移植物存活率的预测因素。多变量分析显示，供体年龄和再次移植仍然具有显著意义（p<0.001 和 p=0.0046）。单变量分析显示，供体年龄（p=0.0176）和移植后 1 个月的肌酐水平（p=0.0271）是患者存活率的预测因素。只有供体年龄在多变量分析中具有显著意义（p=0.0464）。计算出的供体年龄截断值为 60 岁。
在 CIT≥20 小时的情况下，来自 60 岁以下首次接受移植的供体的移植物可以获得满意的长期肾移植结果。诱导治疗最好使用白细胞介素-2 拮抗剂。
