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. Using data from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) (1994-2013), adjusted cox proportional hazard and logistic regression modelling was conducted to examine the relationship between total ischaemic time with graft survival among recipients who received their first deceased donor kidney transplants. 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. There was a significant interaction between total ischaemic time, donor age and graft loss (p value for interaction =0.03). Amongst recipients with older DCDs (age ≥ 55 years), 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].

There appears to be an 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. Interventions that reduce the excess duration of total ischaemia, may improve the overall longevity and utility of deceased donor allografts, particularly for older kidneys from circulatory death.

CITATION INFORMATION: Wong G, Teixeira-Pinto A, Jeremy C, Jonathan C, Stephen M, Wai L. The Impact of Total Ischaemic Time, Donor Age and the Pathway of Donor Death on Graft Outcomes After Deceased Donor Kidney Transplantation. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress