Association of Cold Ischemia Time with Acute Renal Transplant Rejection

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Abstract

Background

Kidney transplantation holds much promise as a treatment of choice for patients with end stage kidney disease. The impact of cold ischemia time (CIT) on acute renal transplant rejection (ARTR) remains to be fully studied in a large cohort of renal transplant patients.

Methods

From the Organ Procurement and Transplantation Network database, we analyzed 63,798 deceased donor renal transplants performed between 2000-2010. We assessed the association between CIT and ARTR. We also evaluated the association between recipient age and ARTR.

Results

6,802 patients (11%) were clinically diagnosed with ARTR. Longer CIT was associated with an increased risk of ARTR. After multivariable adjustment, compared with recipients with CIT<12h, the relative risk of ARTR was 1.13 (95% confidence interval 1.04,1.23) in recipients with CIT≥24h. The association of CIT and ARTR was more pronounced in patients undergoing re-transplantation: compared with recipients with CIT<12h, the relative risk of ARTR was 1.66 (95% confidence interval 1.01,2.73) in recipients with CIT≥24h. Additionally, older age was associated with a decreased risk of ARTR. Compared with recipients 18-29 years old, the relative risk of ARTR was 0.50 (95% confidence interval 0.45, 0.57) in recipients ≥60 years old. Longer CIT was also associated with increased risk of death-censored graft loss. Compared with recipients with CIT<12h, the hazard ratio of death-censored graft loss was 1.22 (95% confidence interval 1.14,1.30) in recipients with CIT≥24h.

Conclusions

Prolonged CIT is associated with an increased risk of ARTR and death-censored graft loss. Older age was associated with a lower risk of ARTR.

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