Abstract
Kidney paired donation (KPD) is an important tool to facilitate living donor kidney transplantation (LDKT). Concerns remain over prolonged cold ischemia times (CIT) associated with shipping kidneys long distances through KPD. We examined the association between CIT and delayed graft function (DGF), allograft survival, and patient survival for 1267 shipped and 205 nonshipped/internal KPD LDKTs facilitated by the National Kidney Registry in the United States from 2008 to 2015, compared to 4800 unrelated, nonshipped, non-KPD LDKTs. Shipped KPD recipients had a median CIT of 9.3 hours (range = 0.25-23.9 hours), compared to 1.0 hour for internal KPD transplants and 0.93 hours for non-KPD LDKTs. Each hour of CIT was associated with a 5% increased odds of DGF (adjusted odds ratio: 1.05, 95% confidence interval [CI], 1.02-1.09, P <.01). However, there was not a significant association between CIT and all-cause graft failure (adjusted hazard ratio [aHR]: 1.01, 95% CI: 0.98-1.04, P =.4), death-censored graft failure ([aHR]: 1.02, 95% CI, 0.98-1.06, P =.4), or mortality (aHR 1.00, 95% CI, 0.96-1.04, P >.9). This study of KPD-facilitated LDKTs found no evidence that long CIT is a concern for reduced graft or patient survival. Studies with longer follow-up are needed to refine our understanding of the safety of shipping donor kidneys through KPD.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 632-641 |
| Number of pages | 10 |
| Journal | American Journal of Transplantation |
| Volume | 18 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 2018 |
Funding
This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C, the National Institutes of Health Training Grant T32-DK-07789, and the UCLA Clinical and Translational Science Institute grant (UL1TR000124). The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The authors alone are responsible for reporting and interpreting these data; the views expressed herein are those of the authors and not necessarily those of the US Government or NKR. Dr. Segev is supported by grant number K24DK101828 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C, the National Institutes of Health Training Grant T32-DK-07789, and the UCLA Clinical and Translational Science Institute grant (UL1TR000124). The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The authors alone are responsible for reporting and interpreting these data; the views expressed herein are those of the authors and not necessarily those of the US Government or NKR. Dr. Segev is supported by grant number K24DK101828 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).?The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government.
Keywords
- clinical research/practice
- delayed graft function (DGF)
- donors and donation: paired exchange
- graft survival
- health services and outcomes research
- kidney transplantation/nephrology
ASJC Scopus subject areas
- Transplantation
- Pharmacology (medical)
- Immunology and Allergy