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Kidney Week

Abstract: TH-PO903

Impact of Donor Warm Ischemia Time on Graft Survival for Donation After Circulatory Death Kidney Transplantation

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Alvino, Donna Marie L., Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Kaul, Sumedh, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Fleishman, Aaron, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Pavlakis, Martha, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Lee, David Donghyung, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Background

To meet demands for kidney transplantation (KT), expanded donor criteria has increased utilization of donation after circulatory death (DCD) donors. Due to ischemic injury associated with DCD organ procurement, the impact of donor warm ischemia time (DWIT) on long-term graft survival has been a notable topic of interest; yet our understanding of this impact on KT outcomes remains limited. Herein, we seek to investigate the impact of DWIT on rates of graft failure after DCD KT.

Methods

Retrospective analysis was conducted on donors and recipients of DCD KT utilizing the Standard Transplant Analysis and Research (STAR) dataset. Demographic data were analyzed and probability of one-year graft failure was assessed based on increasing DWIT using mixed effects logistic regression, stratifying by Kidney Donor Profile Index (KDPI).

Results

From January 2010 to August 2020, 17,169 donors and 22,096 recipients of DCD KT were studied. KPDI decreased from 47% for patients with DWIT 0-45 minutes to 36.5% for DWIT >90 minutes (Table 1). When stratified by KDPI, the impact of increasing DWIT >90 minutes for low KDPI (<50%) recipients was minimal. High KDPI (>50%) recipients demonstrated higher probability of one-year graft failure with increasing DWIT up to 30 minutes compared with low KDPI recipients, but this effect plateaued (Figure 1). No increased probability of graft failure in DWIT >60 minutes was apparent, though confidence intervals widened.

Conclusion

For low KDPI (<50%) kidneys, impact of prolonged DWIT (>60 minutes) on graft survival is minimal, likely reflecting the resilience of higher quality renal allografts to ischemic insult over time. Caution should be taken in considering KT of high KDPI (>50%) kidneys with prolonged DWIT given overall lack of confidence in the existing dataset.