Tennankore Karthik K, Kim S Joseph, Alwayn Ian P J, Kiberd Bryce A
Department of Medicine (Division of Nephrology), Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Kidney Int. 2016 Mar;89(3):648-58. doi: 10.1016/j.kint.2015.09.002. Epub 2015 Dec 30.
Warm ischemia time is a potentially modifiable insult to transplanted kidneys, but little is known about its effect on long-term outcomes. Here we conducted a study of United States kidney transplant recipients (years 2000-2013) to determine the association between warm ischemia time (the time from organ removal from cold storage to reperfusion with warm blood) and death/graft failure. Times under 10 minutes were potentially attributed to coding error. Therefore, the 10-to-under-20-minute interval was chosen as the reference group. The primary outcome was mortality and graft failure (return to chronic dialysis or preemptive retransplantation) adjusted for recipient, donor, immunologic, and surgical factors. The study included 131,677 patients with 35,901 events. Relative to the reference patients, times of 10 to under 20, 20 to under 30, 30 to under 40, 40 to under 50, 50 to under 60, and 60 and more minutes were associated with hazard ratios of 1.07 (95% confidence interval, 0.99-1.15), 1.13 (1.06-1.22), 1.17 (1.09-1.26), 1.20 (1.12-1.30), and 1.23 (1.15-1.33) for the composite event, respectively. Association between prolonged warm ischemia time and death/graft failure persisted after stratification by donor type (living vs. deceased donor) and delayed graft function status. Thus, warm ischemia time is associated with adverse long-term patient and graft survival after kidney transplantation. Identifying strategies to reduce warm ischemia time is an important consideration for future study.
热缺血时间是对移植肾潜在的可改变的损伤因素，但对于其对长期预后的影响却知之甚少。在此，我们对美国肾移植受者（2000 - 2013年）进行了一项研究，以确定热缺血时间（从器官移出冷保存到用温血再灌注的时间）与死亡/移植肾失功之间的关联。10分钟以下的时间可能归因于编码错误。因此，选择10至不足20分钟的时间段作为参照组。主要结局是经受者、供者、免疫和手术因素校正后的死亡率和移植肾失功（恢复慢性透析或先行再次移植）。该研究纳入了131,677例患者，发生35,901起事件。相对于参照患者，10至不足20分钟、20至不足30分钟、30至不足40分钟、40至不足50分钟、50至不足60分钟以及60分钟及以上的热缺血时间与复合事件的风险比分别为1.07（95%置信区间为0.99 - 1.15）、1.13（1.06 - 1.22）、1.17（1.09 - 1.26）、1.20（1.12 - 1.30）和1.23（1.15 - 1.33）。在按供者类型（活体供者与尸体供者）和移植肾功能延迟情况分层后，延长的热缺血时间与死亡/移植肾失功之间的关联依然存在。因此，热缺血时间与肾移植后患者及移植肾的不良长期存活相关。确定减少热缺血时间的策略是未来研究的一个重要考量因素。
