The Impact of Vascular Anastomosis Time on Early Kidney Transplant Outcomes
CUA Online Library. Marzouk K. 06/25/13; 31312; MP-06.11
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Abstract
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INTRODUCTION AND OBJECTIVES: Most studies on deceased donor kidney transplantation have focused on the impact of cold ischemic time on subsequent graft function and graft survival. Relatively less is known about anastomosis time (AT) and the implications on early transplant outcomes. Our objective was to determine whether longer AT's had negative impacts on delayed graft function, serum creatinine levels, as well as length of stay in hospital.
METHODS: This is a retrospective review of 298 solitary deceased donor (DD) kidney recipients with recorded AT's from 1/2006 to 8/2012 during their first hospital stay. The outcomes were incidence of delayed graft function (DGF) defined as the need for dialysis, length of stay in hospital measured in days (DIH) and kidney function measured by serum creatinine in μmol/L at day 7 post transplant. We defined AT as the time between ending the cooling period and successful renal artery anastomosis of the donor kidney. Dependent outcome variables examined in logistic (DGF) and linear regression models (DIH and day 7 creatinine) were adjusted for recipient age, diabetes status and gender, donor age, HLA, MM, cPRA, CMV donor and recipient status, and cold ischemic time (CIT).
RESULTS: DGF was observed in 56 patients (18.5%). AT (mean 35±15) was independently associated with DGF in the fully adjusted logistic regression analysis (Odds Ratio (OR) 1.037 per minute, 95% CI 1.016, 1.057, p=0.001). An AT>29 minutes was associated with a higher rate of DGF (OR 3.5, 95% CI 1.6, 7.3, p=0.001). Mean days in hospital were 12.4 days. AT (B coefficient 0.20 days per minute AT, p<0.001) was associated with longer stays in hospital. Mean creatinine at day 7 was 257 μmol/L (2.9 mg/dL). AT (B coefficient 4.0 μmol/L per minute AT, p<0.001) was associated with a higher creatinine at day 7. CIT was not a predictor of DIH or kidney function. No long term effects were seen on graft or patient survival, however event rates were low.
CONCLUSIONS: An AT>29 min was associated with a 3.5 fold increased risk of DGF. Every 5 minutes of longer AT was associated with 1 extra day in hospital and a serum creatinine 20 μmol/L higher on day 7. AT may be an underappreciated variable in dictating use of hospital resources. Unlike previous DD studies, CIT did not have a significant impact delayed graft function.
METHODS: This is a retrospective review of 298 solitary deceased donor (DD) kidney recipients with recorded AT's from 1/2006 to 8/2012 during their first hospital stay. The outcomes were incidence of delayed graft function (DGF) defined as the need for dialysis, length of stay in hospital measured in days (DIH) and kidney function measured by serum creatinine in μmol/L at day 7 post transplant. We defined AT as the time between ending the cooling period and successful renal artery anastomosis of the donor kidney. Dependent outcome variables examined in logistic (DGF) and linear regression models (DIH and day 7 creatinine) were adjusted for recipient age, diabetes status and gender, donor age, HLA, MM, cPRA, CMV donor and recipient status, and cold ischemic time (CIT).
RESULTS: DGF was observed in 56 patients (18.5%). AT (mean 35±15) was independently associated with DGF in the fully adjusted logistic regression analysis (Odds Ratio (OR) 1.037 per minute, 95% CI 1.016, 1.057, p=0.001). An AT>29 minutes was associated with a higher rate of DGF (OR 3.5, 95% CI 1.6, 7.3, p=0.001). Mean days in hospital were 12.4 days. AT (B coefficient 0.20 days per minute AT, p<0.001) was associated with longer stays in hospital. Mean creatinine at day 7 was 257 μmol/L (2.9 mg/dL). AT (B coefficient 4.0 μmol/L per minute AT, p<0.001) was associated with a higher creatinine at day 7. CIT was not a predictor of DIH or kidney function. No long term effects were seen on graft or patient survival, however event rates were low.
CONCLUSIONS: An AT>29 min was associated with a 3.5 fold increased risk of DGF. Every 5 minutes of longer AT was associated with 1 extra day in hospital and a serum creatinine 20 μmol/L higher on day 7. AT may be an underappreciated variable in dictating use of hospital resources. Unlike previous DD studies, CIT did not have a significant impact delayed graft function.
INTRODUCTION AND OBJECTIVES: Most studies on deceased donor kidney transplantation have focused on the impact of cold ischemic time on subsequent graft function and graft survival. Relatively less is known about anastomosis time (AT) and the implications on early transplant outcomes. Our objective was to determine whether longer AT's had negative impacts on delayed graft function, serum creatinine levels, as well as length of stay in hospital.
METHODS: This is a retrospective review of 298 solitary deceased donor (DD) kidney recipients with recorded AT's from 1/2006 to 8/2012 during their first hospital stay. The outcomes were incidence of delayed graft function (DGF) defined as the need for dialysis, length of stay in hospital measured in days (DIH) and kidney function measured by serum creatinine in μmol/L at day 7 post transplant. We defined AT as the time between ending the cooling period and successful renal artery anastomosis of the donor kidney. Dependent outcome variables examined in logistic (DGF) and linear regression models (DIH and day 7 creatinine) were adjusted for recipient age, diabetes status and gender, donor age, HLA, MM, cPRA, CMV donor and recipient status, and cold ischemic time (CIT).
RESULTS: DGF was observed in 56 patients (18.5%). AT (mean 35±15) was independently associated with DGF in the fully adjusted logistic regression analysis (Odds Ratio (OR) 1.037 per minute, 95% CI 1.016, 1.057, p=0.001). An AT>29 minutes was associated with a higher rate of DGF (OR 3.5, 95% CI 1.6, 7.3, p=0.001). Mean days in hospital were 12.4 days. AT (B coefficient 0.20 days per minute AT, p<0.001) was associated with longer stays in hospital. Mean creatinine at day 7 was 257 μmol/L (2.9 mg/dL). AT (B coefficient 4.0 μmol/L per minute AT, p<0.001) was associated with a higher creatinine at day 7. CIT was not a predictor of DIH or kidney function. No long term effects were seen on graft or patient survival, however event rates were low.
CONCLUSIONS: An AT>29 min was associated with a 3.5 fold increased risk of DGF. Every 5 minutes of longer AT was associated with 1 extra day in hospital and a serum creatinine 20 μmol/L higher on day 7. AT may be an underappreciated variable in dictating use of hospital resources. Unlike previous DD studies, CIT did not have a significant impact delayed graft function.
METHODS: This is a retrospective review of 298 solitary deceased donor (DD) kidney recipients with recorded AT's from 1/2006 to 8/2012 during their first hospital stay. The outcomes were incidence of delayed graft function (DGF) defined as the need for dialysis, length of stay in hospital measured in days (DIH) and kidney function measured by serum creatinine in μmol/L at day 7 post transplant. We defined AT as the time between ending the cooling period and successful renal artery anastomosis of the donor kidney. Dependent outcome variables examined in logistic (DGF) and linear regression models (DIH and day 7 creatinine) were adjusted for recipient age, diabetes status and gender, donor age, HLA, MM, cPRA, CMV donor and recipient status, and cold ischemic time (CIT).
RESULTS: DGF was observed in 56 patients (18.5%). AT (mean 35±15) was independently associated with DGF in the fully adjusted logistic regression analysis (Odds Ratio (OR) 1.037 per minute, 95% CI 1.016, 1.057, p=0.001). An AT>29 minutes was associated with a higher rate of DGF (OR 3.5, 95% CI 1.6, 7.3, p=0.001). Mean days in hospital were 12.4 days. AT (B coefficient 0.20 days per minute AT, p<0.001) was associated with longer stays in hospital. Mean creatinine at day 7 was 257 μmol/L (2.9 mg/dL). AT (B coefficient 4.0 μmol/L per minute AT, p<0.001) was associated with a higher creatinine at day 7. CIT was not a predictor of DIH or kidney function. No long term effects were seen on graft or patient survival, however event rates were low.
CONCLUSIONS: An AT>29 min was associated with a 3.5 fold increased risk of DGF. Every 5 minutes of longer AT was associated with 1 extra day in hospital and a serum creatinine 20 μmol/L higher on day 7. AT may be an underappreciated variable in dictating use of hospital resources. Unlike previous DD studies, CIT did not have a significant impact delayed graft function.
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