Each additional hour of cold ischemia time significantly increases the risk of graft failure and mortality following renal transplantation

Agnes Debout 1, 2 Yohann Foucher 1, 2, 3 Katy Trebern-Launay 1, 2, 3 Christophe Legendre 4, 5, 6 Henri Kreis 4, 5, 6 Georges Mourad 7 Valérie Garrigue 7 Emmanuel Morelon 8 Fanny Buron 8 Lionel Rostaing 9, 10 Nassim Kamar 9, 10 Michèle Kessler 11 Marc Ladrière 11 Alexandra Poignas 12 Amina Blidi 3 Jean-Paul Soulillou 1, 2 Magali Giral 1, 2, * Etienne Dantan 3
* Corresponding author
1 U1064 Inserm - CRTI - Centre de Recherche en Transplantation et Immunologie
2 ITUN - Institut de transplantation urologie-néphrologie
3 Biostatistique, Pharmacoépidémiologie et Mesures Subjectives en Santé
4 Service de Transplantation Rénale et de Soins Intensifs [Hôpital Necker - APHP]
5 UPD5 - Université Paris Descartes - Paris 5
6 USPC - Université Sorbonne Paris Cité
7 Hôpital Lapeyronie [Montpellier] CHU - Service de Néphrologie, Dialyse et Transplantation
8 Service de Transplantation, Néphrologie et Immunologie Clinique [Hôpital Edouard Herriot, HCL]
9 Département de Néphrologie et Transplantation d'organes
Hôpital de Rangueil
10 UT3 - Université Toulouse III - Paul Sabatier
11 Service de Transplantation Rénale [CHU Brabois]
12 CIC biothérapies CBT 0503 [Nantes]
Abstract : Although cold ischemia time has been widely studied in renal transplantation area, there is no consensus on its precise relationship with the transplantation outcomes. To study this, we sampled data from 3839 adult recipients of a first heart-beating deceased donor kidney transplanted between 2000 and 2011 within the French observational multicentric prospective DIVAT cohort. A Cox model was used to assess the relationship between cold ischemia time and death-censored graft survival or patient survival by using piecewise log-linear function. There was a significant proportional increase in the risk of graft failure for each additional hour of cold ischemia time (hazard ratio, 1.013). As an example, a patient who received a kidney with a cold ischemia time of 30 h presented a risk of graft failure near 40% higher than a patient with a cold ischemia time of 6 h. Moreover, we found that the risk of death also proportionally increased for each additional hour of cold ischemia time (hazard ratio, 1.018). Thus, every additional hour of cold ischemia time must be taken into account in order to increase graft and patient survival. These findings are of practical clinical interest, as cold ischemia time is among one of the main modifiable pre-transplantation risk factors that can be minimized by improved management of the peri-transplantation period.
Keywords : patient survival cold ischemia time graft survival kidney transplantation
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Agnes Debout, Yohann Foucher, Katy Trebern-Launay, Christophe Legendre, Henri Kreis, et al.. Each additional hour of cold ischemia time significantly increases the risk of graft failure and mortality following renal transplantation. Kidney International, Nature Publishing Group, 2015, 87 (2), pp.343-349. ⟨10.1038/ki.2014.304⟩. ⟨inserm-02147789⟩

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