Abstract
BackgroundMost studies have found cold ischemic time to be an important predictor of delayed graft function in kidney transplantation. Relatively less is known about the warm time associated with vascular anastomosis and early outcomes.MethodsA retrospective cohort of 298 consecutive solitary deceased donor kidney recipients from January 2006 to August 2012 was analyzed to examine the association between anastomosis time and delayed graft function (need for dialysis) and length of hospital stay.ResultsDelayed graft function (DGF) was observed in 56 patients (18.8%). The median anastomosis time was 30 minutes (interquartile range 24, 45 minutes). Anastomosis time was independently associated with DGF in a multivariable, binary logistic regression analysis (odds Ratio (OR) 1.037 per minute, 95% CI 1.016, 1.057, P = 0.001). An anastomosis time >29 minutes was also associated with a 3.5 fold higher (OR 3.5, 95% CI 1.6, 7.3, P = 0.001) risk of DGF. Median days in hospital was 9 (interquartile range 7, 14 days). Every 5 minutes of longer anastomosis time (0.20 days per minute, 95% CI 0.13, 0.27, P <0.001) was associated with 1 extra day in hospital in a multivariable linear regression model. An anastomosis time >29 minutes was associated with 3.8 (95% CI 1.6, 6.0, P <0.001) more days in hospital.ConclusionAnastomosis time may be an underappreciated but modifiable variable in dictating use of hospital resources. The impact of anastomosis time on longer term outcomes deserves further study.
Highlights
Most studies have found cold ischemic time to be an important predictor of delayed graft function in kidney transplantation
The purpose of this study is to examine the second warm time or the anastomosis time (AT) during the recipient operation and examine whether this contributes to delayed graft function
AT was independently associated with delayed graft function (DGF) in the binary logistic regression analysis (odds ratio (OR) 1.037 per minute, 95% CI 1.016, 1.057, P = 0.001)
Summary
Most studies have found cold ischemic time to be an important predictor of delayed graft function in kidney transplantation. Over the last two decades cold ischemic time (CIT) has been found to be an important independent risk factor for delayed graft function (DGF) in deceased donor kidney transplantation [1,2,3,4]. DGF is associated with inferior graft survival and function [1,2,3]. There are few studies examining the effects of warm ischemic time (WIT) on DGF [5,6]. There is recent information that long WITs may reduce graft survival in live donor kidney transplantation [9]
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