The Authors Reply

Abstract

We thank Drs. Pol and Moers1Pol R.A. Moers C. Minimizing warm ischemic injury in the recipient: don’t rush the anastomosis, but keep the kidney cool.Kidney Int. 2016; (in press)Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar for their interest in our paper2Tennankore K.K. Kim S.J. Alwayn I.P. et al.Prolonged warm ischemia time is associated with graft failure and mortality after kidney transplantation.Kidney Int. 2016; 89: 648-658Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar and insightful comments. We agree that warm ischemia time may not equate to anastomotic time and that redefining it based on the achieved temperature of the transplant kidney should be given consideration. As they suggest, controlled rewarming may ameliorate proapoptotic injury resulting from the rapid temperature increase that accompanies removal from cold storage at the time of surgical anastomosis.1Pol R.A. Moers C. Minimizing warm ischemic injury in the recipient: don’t rush the anastomosis, but keep the kidney cool.Kidney Int. 2016; (in press)Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar, 3Schopp I. Reissberg E. Luër B. et al.Controlled rewarming after hypothermia: adding a new principle to renal preservation.Clin Transl Sci. 2015; 8: 475-478Crossref PubMed Scopus (45) Google Scholar Furthermore, intraoperative cooling techniques4Kamińska D, Kościelska-Kasprzak K, Chudoba P, Klinger M. Kidney injury due to warm ischemia during transplantation can be reduced [e-pub ahead of print]. Am J Transplant. http://dx.doi.org/10.1111/ajt.13641, accessed March 18, 2016.Google Scholar may avoid warm ischemic injury that would accompany lengthy vascular anastomosis times, independent of controlled rewarming. Adoption of these techniques for donor kidney extraction may also be important. As suggested by a recent study, prolonged extraction time may affect posttransplantation outcomes, presumably through ischemic injury.5Osband A.J. James N.T. Segev D.L. Extraction time of kidneys from deceased donors and impact on outcomes.Am J Transplant. 2016; 16: 700-703Crossref PubMed Scopus (22) Google Scholar Acknowledging that these potentially beneficial interventions have not been rigorously evaluated in clinical trials, the vascular anastomosis component of warm ischemia time remains an important factor to consider. We acknowledge that not all prolonged anastomosis times are avoidable and that hurrying the vascular anastomosis may have negative consequences. However, without awareness of the potential impact of prolonged warm ischemia time, concerted efforts to reduce the time of vascular anastomosis in situations in which it is feasible will not be given the attention that is deserved. Prolonged warm ischemia time is associated with graft failure and mortality after kidney transplantationKidney InternationalVol. 89Issue 3PreviewWarm ischemia time is a potentially modifiable insult to transplanted kidneys, but little is known about its effect on long-term outcomes. Here we conducted a study of United States kidney transplant recipients (years 2000–2013) to determine the association between warm ischemia time (the time from organ removal from cold storage to reperfusion with warm blood) and death/graft failure. Times under 10 minutes were potentially attributed to coding error. Therefore, the 10-to-under-20-minute interval was chosen as the reference group. Full-Text PDF Open AccessMinimizing warm ischemic injury in the recipient: don’t rush the anastomosis, but keep the kidney coolKidney InternationalVol. 90Issue 1PreviewWe read with great interest the article by Tennankore et al.1 that provides a comprehensive analysis of the deleterious effect of a prolonged warm ischemia time (WIT) on long-term patient and graft survival after kidney transplantation. These results correspond closely with a recently published study that concluded that a prolonged WIT not only has a detrimental effect on renal allograft outcome immediately after transplantation, but also affects long-term graft function.2 Interestingly, little is known about the actual kidney temperature variations and increase during the WIT. Full-Text PDF Open Archive