van de Laar Stijn C, Lafranca Jeffrey A, Minnee Robert C, Papalois Vassilios, Dor Frank J M F
Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK.
Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, 3015 CN Rotterdam, The Netherlands.
J Clin Med. 2022 Mar 15;11(6):1620. doi: 10.3390/jcm11061620.
Studies have been carried out to investigate the effect of a prolonged cold ischaemia time (CIT) on the outcomes of living donor kidney transplantation (LDKT). There is no clear consensus in the literature about the effects of CIT on LDKT outcomes, and therefore, we performed a systematic review and meta-analysis to provide evidence on this subject. Searches were performed in five databases up to 12 July 2021. Articles comparing different CIT in LDKT describing delayed graft function (DGF), graft and patient survival, and acute rejection were considered for inclusion. This study is registered with PROSPERO, CRD42019131438. In total, 1452 articles were found, of which eight were finally eligible, including a total of 164,179 patients. Meta-analyses showed significantly lower incidence of DGF (odds ratio (OR) = 0.61, p < 0.01), and significantly higher 1-year graft survival (OR = 0.72, p < 0.001) and 5-year graft survival (OR = 0.88, p = 0.04), for CIT of less than 4 h. Our results underline the need to keep CIT as short as possible in LDKT (ideally < 4 h), as a shorter CIT in LDKT is associated with a statistically significant lower incidence of DGF and higher graft survival compared to a prolonged CIT. However, clinical impact seems limited, and therefore, in LDKT programmes in which the CIT might be prolonged, such as kidney exchange programmes, the benefits outweigh the risks. To minimize these risks, it is worth considering including CIT in kidney allocation algorithms and in general take precautions to protect high risk donor/recipient combinations.
已有研究对延长冷缺血时间（CIT）对活体供肾移植（LDKT）结局的影响进行了调查。关于CIT对LDKT结局的影响，文献中尚无明确共识，因此，我们进行了一项系统综述和荟萃分析，以提供关于该主题的证据。检索了截至2021年7月12日的五个数据库。纳入比较LDKT中不同CIT并描述移植肾功能延迟恢复（DGF）、移植物和患者生存率以及急性排斥反应的文章。本研究已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42019131438。总共找到1452篇文章,其中最终有8篇符合条件，共涉及164179例患者。荟萃分析显示，CIT小于4小时时，DGF的发生率显著降低（优势比（OR）=0.61，p<0.01），1年移植物生存率显著提高（OR = 0.72，p<0.001），5年移植物生存率显著提高（OR = 0.88，p = 0.04）。我们的结果强调了在LDKT中尽可能缩短CIT的必要性（理想情况下<4小时），因为与延长的CIT相比，LDKT中较短的CIT与DGF发生率在统计学上显著降低和移植物生存率较高相关。然而，临床影响似乎有限，因此，在CIT可能延长的LDKT项目中，如肾交换项目，益处大于风险。为了将这些风险降至最低，值得考虑将CIT纳入肾脏分配算法，并采取一般预防措施来保护高风险供体/受体组合。
