Anastomosis Time During Kidney Transplantation Influences Long-Term Allograft Function.

Abstract

B: Delayed graft function (DGF) compromises long-term renal allograft function. The influence of the time taken to complete the vascular anastomoses (anastomosis time) on DGF has only sparsely been demonstrated and its influence on long-term graft function is even less characterized. M: From 614 kidney transplantations from brain death donors cold ischemia (start of in situ cold perfusion to start of anastomoses) and anastomosis times (kidney out of ice to reperfusion) were prospectively recorded. The occurrence of DGF and graft function (eGFR) at 3 and 12 months after transplantation were analyzed using multivariate logistic and linear regression methods. Covariates included were anastomosis time, cold ischemia time, HLA mismatch, donor and recipient age. DGF and recipient body mass index (BMI) were added to the model when specified. R: Anastomosis time was an independent risk factor for DGF (OR = 1.058, 95% CI 1.032-1.084). The risk of DGF increased with 63% for every 10 min of anastomosis time. Graft function decreased at 3 and 12 months after transplantation with every 10 min increase in anastomosis time (p < 0.001 and p = 0.024, respectively). Adjusted for cold ischemia time, HLA mismatch, donor and recipient age, anastomosis time was independently associated with worse graft function at 3 and 12 months after transplantation (p = 0.005 and p = 0.038, respectively). Even independently from DGF, anastomosis time remained a risk factor for worse graft function at 3 months (p = 0.019), but not at 12 months. Longer anastomosis time was associated with higher BMI (p = 0.002, correlation coefficient 0.145). Adjusted for BMI, anastomosis time remained an independent risk factor for DGF (OR 1.094, 95% CI 1.037-1.107) and for worse graft function at 3 and 12 months (both p = 0.005). C: In kidney transplants from brain death donors, anastomosis time independently increased the risk of DGF and worsened allograft function up to one year after transplantation. All efforts should be made to reduce the anastomosis time.Figure: No Caption available.