Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Clin Transplant. 2018 Mar;32(3):e13185. doi: 10.1111/ctr.13185. Epub 2018 Jan 30.
To determine the impact of prolonged cold ischemia time (CIT) on the outcome of acute kidney injury (AKI) renal grafts, we therefore performed a single-center retrospective analysis in adult patients receiving kidney transplantation (KT) from AKI donors. Outcomes were stratified according to duration of CIT. A total of 118 patients receiving AKI grafts were enrolled. Based on CIT, patients were stratified as follows: (i) <20 hours, 27 patients; (ii) 20-30 hours, 52 patients; (iii) 30-40 hours, 30 patients; (iv) ≥40 hours, nine patients. The overall incidence of delayed graft function DGF was 41.5%. According to increasing CIT category, DGF rates were 30%, 42%, 40%, and 78%, respectively (P = .03). With a mean follow-up of 48 months, overall patient and graft survival rates were 91% and 81%. Death-censored graft survival (DCGS) rates were 84% and 88% for patients with and without DGF (P = NS). DCGS rates were 92% in patients with CIT <20 hours compared to 85% with CIT >20 hours (P = NS). In the nine patients with CIT >40 hours, the 4-year DCGS rate was 100%. We conclude that prolonged CIT in AKI grafts may not adversely influence outcomes and so discard of AKI kidneys because of projected long CIT is not warranted when donors are wisely triaged.
为了确定长时间冷缺血时间（CIT）对急性肾损伤（AKI）供肾移植结局的影响，我们对接受 AKI 供者肾移植（KT）的成年患者进行了单中心回顾性分析。根据 CIT 持续时间对结果进行分层。共纳入 118 例接受 AKI 移植物的患者。根据 CIT，患者分层如下：（i）<20 小时，27 例；（ii）20-30 小时，52 例；（iii）30-40 小时，30 例；（iv）≥40 小时，9 例。总体延迟移植物功能（DGF）发生率为 41.5%。根据 CIT 类别递增，DGF 发生率分别为 30%、42%、40%和 78%（P=.03）。平均随访 48 个月，患者和移植物总生存率分别为 91%和 81%。无 DGF 患者和有 DGF 患者的死亡相关移植物生存率（DCGS）分别为 84%和 88%（P=NS）。CIT<20 小时的患者 DCGS 率为 92%，而 CIT>20 小时的患者为 85%（P=NS）。在 CIT>40 小时的 9 例患者中，4 年 DCGS 率为 100%。我们得出结论，AKI 移植物中长时间的 CIT 可能不会对结局产生不利影响，因此，当明智地对供者进行分类时，不应因为预计 CIT 长而放弃 AKI 肾脏。
