The impact of total ischaemic time, donor age and the pathway of donor death on graft outcomes after deceased donor kidney transplantation.

Background: Prolonged ischaemia is a known risk factor for delayed graft function and its interaction with donor characteristics, the pathways of donor death and graft outcomes may have important implications for allocation policies. Methods: Using data from the ANZDATA registry (1994-2013), we examined the relationship between total ischaemic time with graft outcomes among recipients who received their first deceased donor kidney transplants. Total ischaemic time (in hours) was defined as the time of the donor renal artery interruption or aortic clamp, until the time of release of the clamp on the renal artery in the recipient. Results: A total of 7,542 recipients were followed over a median follow-up time of 5.3 years (interquartile range of 8.2 years). Of these, 1823 (24.6%) experienced delayed graft function (DGF) and 2553 (33.9%) experienced allograft loss. Recipients with total ischaemic time >= 14 hours experienced an increased odd of delayed graft function (DGF) compared to those with total ischaemic time less than 14 hours. This effect was most marked amongst those with older donors (p value for interaction = 0.01). There was a significant interaction between total ischaemic time, donor age and graft loss (p value for interaction =0.03). There was on average, a 9% increase in the overall risk of graft loss per hour increase in the total ischaemic time [adjusted hazard ratio (HR): 1.09, 95%CI: 1.01 - 1.18, p = 0.02] in recipients with older DCD grafts. Conclusion: There is a clinically important interaction between donor age, the pathway of donor death and total ischaemic time on graft outcomes, such that the duration of ischaemic time has the greatest impact on graft survival in recipients with older DCD kidneys. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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