Impact of Early Lymph Node Procurement to Facilitate Histocompatibility Testing on Long-Term Cadaveric Kidney Graft Survival

Abstract

Background Prolonged cold ischemia time (CIT) is a clinically important causes of delayed graft function (DGF) after kidney transplantation. As DGF has been previously shown to have a deleterious influence on long-term graft survival, in the present study we analyzed the impact of early lymph node (LN) procurement on CIT, HLA mismatches, and long-term kidney graft outcome. Materials and Methods We evaluated 394 consecutive cadaveric procedures performed from 2001 to 2006, including 289 recipients, in whom LN were obtained before kidney procurement seeking to shorten the total time for HLA typing and crossmatch procedures. Results During 58 ± 6 months, 24 patients died (918 [8.3%] in the early and 6 [5.7%] in late procurement group, P = ns) and 52 lost their kidney grafts (31 [10.7%] vs 21 [20%]; P = .025). Early procurement of LN performed in 73.4% of all kidney graft recipients shortened CIT by almost 7 hours (22.9 vs 16.1 hours; P < .001), with a nonsignificantly lower incidence of DGF (32.2% vs 41.0%; P = .13). However, a Cox proportional hazards regression model revealed that early procurement reduced the risk of death-censored kidney graft loss by roughly 40% (log-rank, P = .013). Conclusion Early LN procurement in significantly shorten CIT and subsequently reduced the risk of long-term kidney graft loss.