Vinson Amanda J, Rose Caren, Kiberd Bryce A, Odutayo Ayodele, Kim S Joseph, Alwayn Ian, Tennankore Karthik K
Division of Nephrology, Department of Medicine, Dalhousie University, Nova Scotia, Canada.
Division of Nephrology, University of British Columbia, St. Paul's Hospital Vancouver, Canada.
Transplant Direct. 2018 Apr 18;4(5):e342. doi: 10.1097/TXD.0000000000000781. eCollection 2018 May.
Prolonged warm ischemia time (WIT) is associated with graft failure and mortality, however less is known about factors associated with prolonged WIT.
In a cohort of United States deceased donor kidney transplant recipients identified using the Scientific Registry of Transplant Recipients (Jan 2005-Dec 2013), we identified factors associated with prolonged WIT (defined as ≥ 30 minutes versus 10-30 minutes) using hierarchical multilevel models adjusting for center effect, and WIT as a continuous variable using multiple linear regression of log-transformed data.
Among 55 829 patients, potentially modifiable risk factors associated with prolonged WIT included increased recipient body mass index (BMI) (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.44-1.72 for BMI > 35), right donor kidney (OR, 1.14; 95% CI, 1.08-1.19), and a prolonged cold ischemic time (OR, 1.23; 95% CI, 1.13-1.33 for cold ischemia time > 24 hours). Transplanting a right kidney into an obese recipient further prolonged WIT (OR, 1.75; 95% CI, 1.55-1.98; for BMI > 35), increasing overall WIT by 11.0%. There was no correlation between median WIT for a given center and annual center transplant rate (pairwise correlation coefficient, 0.0898).
In conclusion, several modifiable factors are associated with prolonged WIT and may represent strategies to improve WIT and subsequent posttransplant outcomes.
长时间的热缺血时间（WIT）与移植肾失败和死亡率相关，但关于与长时间WIT相关的因素知之甚少。
在一组使用移植受者科学登记系统（2005年1月至2013年12月）确定的美国已故供体肾移植受者中，我们使用分层多水平模型调整中心效应，确定与长时间WIT（定义为≥30分钟与10 - 30分钟相比）相关的因素，并使用对数转换数据的多元线性回归将WIT作为连续变量进行分析。
在55829例患者中，与长时间WIT相关的潜在可改变危险因素包括受者体重指数（BMI）增加（比值比[OR]，1.57；95%置信区间[CI]，BMI>35时为1.44 - 1.72）、右供肾（OR，1.14；95%CI，1.08 - 1.19）和冷缺血时间延长（OR，冷缺血时间>24小时时为1.23；95%CI，1.13 - 1.33）。将右肾移植给肥胖受者会进一步延长WIT（OR，1.75；95%CI，1.55 - 1.98；BMI>35时），使总体WIT增加11.0%。给定中心的中位WIT与年度中心移植率之间无相关性（成对相关系数，0.0898）。
总之，几个可改变的因素与长时间WIT相关，可能代表改善WIT及后续移植后结局的策略。
