Interaction between cold ischemia time and Kidney Donor Profile Index on postrenal transplant outcomes

Authors

Winn T. Cashion, Department of Medicine, Division of Nephrology, Maine Health, Portland, ME, USA.Follow
Xingyu Zhang, Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Chethan Puttarajappa, Department of Medicine, Division of Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Akhil Sharma, Department of Medicine, Division of Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Rajil Mehta, Department of Medicine, Division of Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Armando Ganoza, Department of Surgery, Division of Transplantation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Vikraman Gunabushanam, Department of Surgery, Division of Transplantation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Puneet Sood, Department of Medicine, Division of Nephrology, University of California San Francisco, CA, USA.
Christine Wu, Department of Medicine, Division of Nephrology, Pittsburgh VA Medical Center, Pittsburgh, Pennsylvania, USA.
Aravind Cherukuri, Department of Medicine, Division of Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Document Type

Article

Publication Date

5-2024

Institution/Department

Nephrology & Transplantation

Journal Title

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

MeSH Headings

Humans; Kidney Transplantation; Cold Ischemia; Male; Female; Graft Survival; Middle Aged; Tissue Donors (supply & distribution); Glomerular Filtration Rate; Risk Factors; Adult; Follow-Up Studies; Delayed Graft Function (etiology); Prognosis; Survival Rate; Retrospective Studies; Kidney Failure, Chronic (surgery); Graft Rejection (etiology); Kidney Function Tests; Tissue and Organ Procurement; Postoperative Complications

Abstract

We analyzed whether there is an interaction between the Kidney Donor Profile Index (KDPI) and cold ischemia time (CIT) in recipients of deceased donor kidney transplant (KTs). Adults who underwent KTs in the United States between 2014 and 2020 were included and divided into 3 KDPI groups (≤20%, 21%-85%, >85%) and 4 CIT strata (85%. Increasing KDPI and CIT were associated with worse post-KT outcomes. Contrary to our hypothesis, howerver, the interaction between KDPI and CIT was statistically significant only for PGNF and DGF and eGFR at 6 months. Paradoxically, the negative coefficient of the interaction suggested that increasing duration of CIT was more detrimental for low and intermediate-KDPI organs relative to high-KDPI grafts. Conversely, for mortality, graft survival, and DCGS, we found that the interaction between CIT and KDPI was not statistically significant. We conclude that, high KDPI and prolonged CIT are independent risk factors for inferior outcomes after KT. Their interaction, however, is statistically significant only for the short-term outcomes and more pronounced on low and intermediate-KDPI grafts than high-KDPI kidneys.

First Page

781

Last Page

794

Recommended Citation

Cashion WT, Zhang X, Puttarajappa C, et al. Interaction between cold ischemia time and Kidney Donor Profile Index on postrenal transplant outcomes. Am J Transplant. 2024;24(5):781-794. doi:10.1016/j.ajt.2024.01.026