Is there a Safe Cold Ischemia Time Interval for the Renal Graft?
Is there a Safe Cold Ischemia Time Interval for the Renal Graft?
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DOI：
10.1016/j.acuroe.2011.03.007
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发表时间：
2011-09-01
影响因子：
1.1
通讯作者：
Pascual, I.
中科院分区：
文献类型：
--
作者：
Barba, J.;Zudaire, J. J.;Pascual, I.
目的：探讨冷缺血时间(CIT)与移植肾存活率及术后主要事件的关系。材料与方法：对378例肾移植患者进行分析，根据Cox模型进行单因素分析，根据Kaplan-Meier法和LOG-RANK检验寻找最佳切割点。结果：平均随访77.8个月(+/-51SD)，平均CIT为14.8h(+/-5.1SD)。单因素分析显示CIT与移植物存活率无相关性(OR=1.04；95%CI：0.9~1.08；p>；0.05)。在建立18小时的截止时间时，我们发现精算存活率存在差异。CIT+lt；18h组5年生存率为91%，CIT+Gt；18h组为84%。冷缺血每小时使移植肾功能延迟风险增加10%(OR=1.1；95%CI：1.05-1.15；p<；0.001)，18小时后急性排斥反应发生率增加(41.5%比55.3%；p=0.02)，首次排斥反应发生时间缩短(72.6d+/-137d比272.2天+/-614.8；p=0.023)。CIT似乎与移植后的其他事件无关(p<；0.05)，例如手术并发症或住院。结论：根据我们的经验，冷缺血18小时以下似乎不会对移植物存活产生负面影响。(C)2011年AEU。由Elsevier Espana，S.L.出版，版权所有。
Objective: It is aimed to characterize the true relationship of the cold ischemia time (CIT) with graft survival and with the principal post-transplantation events.Material and methods: We analyzed 378 kidney transplants, studying the relationship of the CIT with graft survival using a univariate analysis according to the COX model and seeking the optimum cutoff according to the Kaplan-Meier method and log-rank test. The relationship between CIT and the principal events of the post-transplant was studied using the binary logistic regression.Results: The mean follow-up of all the group was 77.8 months (+/- 51 SD) and the mean CIT was 14.8 hours (+/- 5.1 SD). The univariate analysis revealed that the CIT was not related with the graft survival as a continuous variable (OR = 1.04; 95% CI: 0.9-1.08; p > 0.05). On establishing the cutoff at 18 hours, we found differences in the actuarial survival. Survival at 5 years was 91% with CIT < 18h versus 84% with CIT >18h. Each hour of cold ischemia increased risk of delay in the graft function by 10% (OR = 1.1; 95% CI: 1.05-1.15; p < 0.001) and also conditioned a greater incidence of acute rejection (41.5% vs. 55.3%; p = 0.02) and less time to the first rejection episode (72.6 days +/- 137 vs. 272.2 days +/- 614.8; p = 0.023) after 18 hours. The CIT did not seem to be related (p < 0.05) with the rest of the post-transplantation events, such as surgical complications or hospital admissions.Conclusions: In our experience, cold ischemia under 18 hours does not seem to negatively affect graft survival. (C) 2011 AEU. Published by Elsevier Espana, S.L. All rights reserved.