Objective: Most studies have focused on the impact of factors such as donor age, gender and cold ischemic time on subsequent graft function and graft survival. Relatively less is known about anastomosis time (AT) and early transplant outcomes. Our objective was to determine whether longer ATs had negative impacts on delayed graft function, serum creatinine levels, as well as length of stay in hospital.
Methods: In this retrospective chart review, 303 consecutive solitary deceased donor (DD) kidney recipients from 1/2006 to 8/2012 with recorded ATs were analyzed. The outcomes were incidence of delayed graft function (DGF) defined as need for dialysis, length of stay in hospital (DIH), and kidney function (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 and gender, 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) 1.029 per minute, 95% CI 1.009, 1.05, p=0.005). An AT >29 minutes was associated with a higher rate of DGF (OR 3.3, 95% CI 1.5, 6.9, p=0.002). 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. An AT >29 minutes was associated with 3.8 days longer in hospital. Mean creatinine at day 7 was 256 Μmol/L (2.9 mg/dL). AT (B coefficient 3.7 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.
Conclusion: Every 5 minutes of longer AT was associated with 1 extra day in hospital and a serum creatinine 18.5 Μmol/L higher on day 7. An AT >29 min was associated with a 3 fold increased risk of DGF and nearly 4 more days in hospital. AT may be an underappreciated but modifiable variable in dictating use of hospital resources. Unlike previous DD studies, CIT did not have a significant impact delayed graft function in our cohort.
To cite this abstract in AMA style:Marzouk K, Kiberd B, Lawen J, Alwayn I. Surgical Anastomosis Time and Its Effect on Delayed Graft Function and Early Outcomes in Deceased Donor Kidney Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/surgical-anastomosis-time-and-its-effect-on-delayed-graft-function-and-early-outcomes-in-deceased-donor-kidney-transplantation/. Accessed November 24, 2020.
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