Jouni Lauronen1, Juha P Peräsaari2, Timo Saarinen2, Taina Jaatinen2, Marko Lempinen3, Ilkka Helanterä3. 1. Finnish Red Cross Blood Service, Helsinki, Finland. Electronic address: jouni.lauronen@veripalvelu.fi. 2. Finnish Red Cross Blood Service, Helsinki, Finland. 3. Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Abstract
BACKGROUND: Long cold ischemia time (CIT) is the most important factor contributing to delayed graft function (DGF) after kidney transplant. Improvements in pretransplant procedures may reduce CIT and improve clinical outcome. MATERIALS AND METHODS: Pretransplant histocompatibility tests were modernized at our laboratory in 2015, leading to significant decrease of time consumed for these enabling earlier surgery. The effects of this on kidney transplant CIT, DGF, and other clinical outcomes were studied. The study population consisted of 896 consecutive deceased donor kidney recipients, of which 442 patients received a transplant with the old crossmatch and 454 received a transplant with the new crossmatch. RESULTS: CIT shortened from mean 20 hours 6 minutes to 15 hours 52 minutes (P < .001). The incidence of DGF was significantly reduced from 31% to 24% (P = .02). Reduction in the frequency of DGF was more pronounced among the highly sensitized patients (53% to 28%, P = .01) or in patients with pretransplant donor-specific antibodies (50% to 20%, P = .002) and among patients who received kidneys from donors older than 65 years (38% to 27%, P = .04). CONCLUSIONS: Process optimization that reduces CIT decreases occurrence of DGF, especially in highly sensitized patients and patients who receive kidneys from older donors.
BACKGROUND: Long cold ischemia time (CIT) is the most important factor contributing to delayed graft function (DGF) after kidney transplant. Improvements in pretransplant procedures may reduce CIT and improve clinical outcome. MATERIALS AND METHODS: Pretransplant histocompatibility tests were modernized at our laboratory in 2015, leading to significant decrease of time consumed for these enabling earlier surgery. The effects of this on kidney transplant CIT, DGF, and other clinical outcomes were studied. The study population consisted of 896 consecutive deceased donor kidney recipients, of which 442 patients received a transplant with the old crossmatch and 454 received a transplant with the new crossmatch. RESULTS: CIT shortened from mean 20 hours 6 minutes to 15 hours 52 minutes (P < .001). The incidence of DGF was significantly reduced from 31% to 24% (P = .02). Reduction in the frequency of DGF was more pronounced among the highly sensitized patients (53% to 28%, P = .01) or in patients with pretransplant donor-specific antibodies (50% to 20%, P = .002) and among patients who received kidneys from donors older than 65 years (38% to 27%, P = .04). CONCLUSIONS: Process optimization that reduces CIT decreases occurrence of DGF, especially in highly sensitized patients and patients who receive kidneys from older donors.
Authors: Stijn C van de Laar; Jeffrey A Lafranca; Robert C Minnee; Vassilios Papalois; Frank J M F Dor Journal: J Clin Med Date: 2022-03-15 Impact factor: 4.241