The Impact of Anastomosis Time During Kidney Transplantation on Graft Loss: A Eurotransplant Cohort Study
The Impact of Anastomosis Time During Kidney Transplantation on Graft Loss: A Eurotransplant Cohort Study
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DOI：
10.1111/ajt.14031
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发表时间：
2017-03-01
影响因子：
8.8
通讯作者：
Jochmans, I.
中科院分区：
文献类型：
--
作者：
Heylen, L.;Pirenne, J.;Jochmans, I.
最近的研究提出了这样的担忧，即肾移植中血管吻合完成时的热缺血损害了移植，但其对预后的确切影响及其与其他危险因素的相互作用仍有待确定。我们调查了欧洲移植地区13964例已故供者孤立肾移植受者的吻合时间与移植后5年存活率的关系。在调整了其他危险因素(调整后的风险比[HR]为每增加10分钟，95%可信区间[CI]1.06-1.14；P<；0.0001)后，吻合时间与移植物丢失独立相关，但不影响受体的存活率(HR为1.00，95%可信区间为0.97-1.02)。循环死亡后捐献的肾脏(DCD)对延长吻合口时间的耐受性低于脑死亡后捐献的肾脏(p=0.02)。吻合口时间与供体热缺血时间(WIT)的相加效应解释了这一观察结果，因为DCD状态不再与移植物存活相关，并且DCD状态和WIT之间没有交互作用。在肾移植中建立血管吻合的时间与较差的移植结果有关，尤其是在DCD肾脏的受者。
Recent studies raised the concern that warm ischemia during completion of vascular anastomoses in kidney implantation harms the transplant, but its precise impact on outcome and its interaction with other risk factors remain to be established. We investigated the relationship between anastomosis time and graft survival at 5 years after transplantation in 13 964 recipients of deceased donor solitary kidney transplants in the Eurotransplant region. Anastomosis time was independently associated with graft loss after adjusting for other risk factors (adjusted hazard ratio [HR] 1.10 for every 10-min increase, 95% confidence interval [CI] 1.06-1.14; p < 0.0001), whereas it did not influence recipient survival (HR 1.00, 95% CI 0.97-1.02). Kidneys from donation after circulatory death (DCD) were less tolerant of prolonged anastomosis time than kidneys from donation after brain death (p = 0.02 for interaction). The additive effect of anastomosis time with donor warm ischemia time (WIT) explains this observation because DCD status was no longer associated with graft survival when adjusted for this summed WIT, and there was no interaction between DCD status and summed WIT. Time to create the vascular anastomoses in kidney transplantation is associated with inferior transplant outcome, especially in recipients of DCD kidneys.