Organs with Extended Cold Ischemia Time May Offer Aged Kidney Transplant Recipients New Options in an Expanded Donor Pool.
1Transplantation Research Center, Brigham and Women's Hospital, Boston, MA
2Renal Division, Brigham and Women's Hospital, Boston, MA
Meeting: 2017 American Transplant Congress
Abstract number: 133
Keywords: Age factors, Kidney transplantation, Rejection, Renal ischemia
Session Information
Session Name: Concurrent Session: Kidney: Acute Cellular Rejection
Session Type: Concurrent Session
Date: Sunday, April 30, 2017
Session Time: 4:30pm-6:00pm
Presentation Time: 4:54pm-5:06pm
Location: E451b
Using data from the largest cohort of renal transplants, the aim of this study was to examine the effects of cold ischemia times (CIT) on acute renal transplant rejection (ARTR). We analyzed a total of 121,126 deceased donor kidney transplants performed between 1987 and 2010 and assessed the interaction between age of the host and the rate of ARTR of ischemic organs.
The incidence of ARTR increased with ischemia, and odds ratio for ARTR was 1.03 per hour of CIT. This effect remained significant after accounting for recipient age, donor age and HLA mismatching.
| Table 1. | Multivariate Analysis of Covariates for Acute Graft Rejection | |||||
| Covariate | Odds Ratio | P-value | 95% CI | |||
| Cold Ischemia Time (<8 h*) | ||||||
| 8-16 h | 1.12 | <0.001 | 1.06-1.19 | |||
| 16-24 h | 1.42 | <0.001 | 1.34-1.50 | |||
| 24-32 h | 1.70 | <0.001 | 1.61-1.81 | |||
| >32 h | 2.21 | <0.001 | 2.08-2.36 | |||
| Recipient Age | 0.14 | <0.001 | 0.13-0.15 | |||
| Donor Age | 1.21 | <0.001 | 1.12-1.30 | |||
| HLA Mismatch (Y vs. N) | 1.90 | <0.001 | 1.81-2.00 | |||
| *All CIT groups used <8 h as the comparison group | ||||||
Increasing recipient age blunted the effect of CIT on ARTR. 45.2% of recipients of kidneys with >32 hours CIT experienced ARTR among the 18-29 recipient age group and 13.3% among ≥70 recipient age group.
Death-censored median graft survival was 8.7 years in the 18-39 age group, 11.1 years in the 40-59 age group, and 13.7 years in the ≥60 age group for patients with highly ischemic (>32 h) kidneys that experienced ARTR.
While prolonged CIT increases the rate of ARTR, older recipients may be less susceptible to ischemia and subsequent ARTR episodes. These findings have the potential to expand utilization of ischemic organs with an affirmative outcome in elderly population.
CITATION INFORMATION: Postalcioglu M, Byun B, Kaze A, Siedlecki A, Milford E, Abdi R. Organs with Extended Cold Ischemia Time May Offer Aged Kidney Transplant Recipients New Options in an Expanded Donor Pool. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Postalcioglu M, Byun B, Kaze A, Siedlecki A, Milford E, Abdi R. Organs with Extended Cold Ischemia Time May Offer Aged Kidney Transplant Recipients New Options in an Expanded Donor Pool. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/organs-with-extended-cold-ischemia-time-may-offer-aged-kidney-transplant-recipients-new-options-in-an-expanded-donor-pool/. Accessed November 21, 2024.« Back to 2017 American Transplant Congress