Cojuc-Konigsberg Gabriel, Rivera Belen, Cañizares Stalin, Pavlakis Martha, Eckhoff Devin, Chopra Bhavna
Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Division of Transplant Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Clin Transplant. 2024 Dec;38(12):e70051. doi: 10.1111/ctr.70051.
The association between prolonged cold ischemia times (CIT), donor age, and outcomes in kidney transplant recipients (KTRs) from donors after circulatory death (DCD) remains uncertain. We aimed to compare allograft outcomes in DCD-donor KTRs according to CIT and age.
UNOS database study (2010-2024) of DCD-donor KTRs on tacrolimus maintenance. We developed a mate-kidney analysis, comparing outcomes where one mate kidney had CIT >24 and the other ≤24 h. We evaluated patient death, all-cause allograft failure, and death-censored graft failure (DCGF) using multivariable stratified Cox proportional hazards models. We compared outcomes across age groups (≥50 or <50 years) and 6-h-period CIT deltas between mate kidneys. We assessed delayed graft function (DGF) occurrence with multivariable conditional logistic regression.
We included 4092 DCD-donor mate-kidney pairs. There were no differences between CIT >24 versus ≤24 h in patient death (aHR 1.12, 95% CI 0.97-1.30), all-cause allograft failure (aHR 1.10, 95% CI 0.98-1.24), or DCGF (aHR 1.07, 95% CI 0.90-1.27). Similar results were observed when comparing outcomes by age group and 6-h-period CIT deltas between mate kidneys. Compared to shorter CITs, CITs >24 h were associated with increased DGF likelihood (aOR 1.42, 95% CI 1.25-1.60), as were increasing CIT deltas.
CITs >24 h in DCD-donor KTRs were not associated with adverse allograft outcomes, irrespective of age group. However, prolonged CITs were associated with increased DGF likelihood. Increasing the acceptance of both mate kidney from DCD donors should be considered despite projected CITs >24 h.
循环死亡后供体（DCD）的肾移植受者（KTRs）中，冷缺血时间延长（CIT）、供体年龄与预后之间的关联仍不明确。我们旨在根据CIT和年龄比较DCD供体KTRs的同种异体移植预后。
对接受他克莫司维持治疗的DCD供体KTRs进行UNOS数据库研究（2010 - 2024年）。我们开展了配对肾分析，比较一侧配对肾CIT>24小时而另一侧≤24小时的预后情况。我们使用多变量分层Cox比例风险模型评估患者死亡、全因同种异体移植失败和死亡删失的移植失败（DCGF）。我们比较了不同年龄组（≥50岁或<50岁）以及配对肾之间6小时时间段的CIT差值的预后情况。我们使用多变量条件逻辑回归评估延迟移植功能（DGF）的发生情况。
我们纳入了4092对DCD供体配对肾。CIT>24小时与≤24小时在患者死亡（校正风险比[aHR]1.12，95%置信区间[CI]0.97 - 1.30）、全因同种异体移植失败（aHR 1.10，95% CI 0.98 - 1.24）或DCGF（aHR 1.07，95% CI 0.90 - 1.27）方面无差异。在按年龄组和配对肾之间6小时时间段的CIT差值比较预后时，观察到了类似结果。与较短的CIT相比，CIT>24小时与DGF可能性增加相关（校正比值比[aOR]1.42，95% CI 1.25 - 1.60），CIT差值增加时也是如此。
在DCD供体KTRs中，CIT>24小时与不良同种异体移植预后无关，无论年龄组如何。然而，延长的CIT与DGF可能性增加相关。尽管预计CIT>24小时，仍应考虑增加对来自DCD供体的双侧配对肾的接受度。
