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Association of Cold Ischemia Time With Acute Renal Transplant Rejection

Postalcioglu, Merve, MD1; Kaze, Arnaud D., MD, MPH2; Byun, Benjamin C.1; Siedlecki, Andrew, MD1; Tullius, Stefan G., MD, PhD3; Milford, Edgar L., MD2; Paik, Julie M., MD, MPH, MSc2; Abdi, Reza, MD1

doi: 10.1097/TP.0000000000002106
Original Clinical Science—General

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 and 2010. We assessed the association between CIT and ARTR. We also evaluated the association between recipient age and ARTR.

Results Six thousand eight hundred two (11%) patients were clinically diagnosed with ARTR. Longer CIT was associated with an increased risk of ARTR. After multivariable adjustment, compared with recipients with CIT < 12 hours, the relative risk of ARTR was 1.13 (95% confidence interval, 1.04-1.23) in recipients with CIT ≥ 24 hours. The association of CIT and ARTR was more pronounced in patients undergoing retransplantation: compared with recipients with CIT less than 12 hours, the relative risk of ARTR was 1.66 (95% confidence interval, 1.01-2.73) in recipients with CIT of 24 hours or longer. Additionally, older age was associated with a decreased risk of ARTR. Compared with recipients aged 18 to 29 years, the relative risk of ARTR was 0.50 (95% confidence interval, 0.45-0.57) in recipients 60 years or older. Longer CIT was also associated with increased risk of death-censored graft loss. Compared with recipients with CIT less than 12 hours, the hazard ratio of death-censored graft loss was 1.22 (95% confidence interval, 1.14-1.30) in recipients with CIT of 24 hours or longer.

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.

Prolonged cold ischemia time is associated with an increased risk of acute renal transplant rejection (ARTR) and death-censored graft loss, however older age is associated with a lower risk of ARTR.

1 Transplantation Research Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.

2 Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.

3 Division of Transplant Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.

Received 15 October 2017. Revision received 21 November 2017.

Accepted 20 December 2017.

This work was supported by NIH grant K24 AI116925 (RA).

M.P. and A.D.K. contributed equally to the study.

The authors declare no conflicts of interest.

M.P. participated in the study conception, data analysis and interpretation, article preparation, and critical editing. A.D.K. participated in the study conception, data analysis and interpretation, article preparation, and critical editing. B.C.B. participated in the data analysis and interpretation and article preparation. A.S. participated in the study conception and data analysis and interpretation. S.G.T. participated in the study conception. E.L.M. participated in the study conception and data analysis and interpretation. J.M.P. participated in the data analysis and interpretation, article preparation, and critical editing. R.A. participated in the study conception, data analysis and interpretation, and critical editing.

Correspondence: Reza Abdi, MD, Brigham & Women's Hospital Transplantation Research Center, EBRC 221 Longwood Ave, 3. Floor Boston, MA 02115. (Rabdi@partners.org).

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