Geographic Variation in Cold Ischemia Time: Kidney Vs. Liver Transplantation in the United States, 2003-2011

Overview

Journal Transplant Direct

Publisher Wolters Kluwer

Specialty General Surgery

Date 2015 Nov 24

PMID 26594661

Citations 5

Authors

Naoru Koizumi

Debasree DasGupta

Amit V Patel

Tony E Smith

Jeremy D Mayer

Clive Callender

Joseph K Melancon

Affiliations

Soon will be listed here.

Abstract

Background: Regional variations in kidney and liver transplant outcomes have been reported, but their causes remain largely unknown. This study investigated variations in kidney and liver cold ischemia times (CITs) across Organ Procurement Organizations (OPO) as potential causes of variations in transplant outcomes.

Methods: This retrospective study analyzed the Standard Transplant Analysis and Research (STAR) data of deceased donor kidney (n=61,335) and liver (n=39,285) transplants performed between 2003 and 2011. CIT variations between the two types of organs were examined and compared. Factors associated with CIT were explored using multivariable regressions. Spearman's rank tests were used to associate CIT with graft failure at the OPO level.

Results: Significant CIT variations were found across OPOs for both organs (p < 0.05). The variation was particularly large for kidney CIT. Those OPOs with longer average kidney CIT were likely to have a lower graft survival rate (p=0.01). For liver, this association was insignificant (p=0.23). The regression analysis revealed sharp contrasts between the factors associated with kidney and liver CITs. High risk kidney transplant recipients and marginal kidneys were associated with average CIT. The reverse was true for liver transplants.

Conclusions: Large variations in kidney CIT compared to liver CIT may indicate that there is a room to reduce kidney CIT. Reducing kidney CIT through managerial improvements could be a cost effective way to improve the current transplant system.

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References

Donnelly P, Henderson R, Price D . Professional attitudes to bioethical issues ration the supply of "marginal living donor" kidneys for transplantation. Transplant Proc. 1999; 31(1-2):1349-51. DOI: 10.1016/s0041-1345(98)02023-5. View

Totsuka E, Fung J, Lee M, Ishii T, Umehara M, Makino Y . Influence of cold ischemia time and graft transport distance on postoperative outcome in human liver transplantation. Surg Today. 2002; 32(9):792-9. DOI: 10.1007/s005950200152. View

Tullius S, Reutzel-Selke A, Nieminen-Kelha M, Jonas S, Egermann F, Heinzelmann T . Contribution of donor age and ischemic injury in chronic renal allograft dysfunction. Transplant Proc. 1999; 31(1-2):1298-9. DOI: 10.1016/s0041-1345(98)02004-1. View

Port F, Bragg-Gresham J, Metzger R, Dykstra D, Gillespie B, Young E . Donor characteristics associated with reduced graft survival: an approach to expanding the pool of kidney donors. Transplantation. 2002; 74(9):1281-6. DOI: 10.1097/00007890-200211150-00014. View

Yersiz H, Shaked A, Olthoff K, Imagawa D, Shackleton C, MARTIN P . Correlation between donor age and the pattern of liver graft recovery after transplantation. Transplantation. 1995; 60(8):790-4. View

Ojo A, Hanson J, Meier-Kriesche H, Okechukwu C, Wolfe R, Leichtman A . Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol. 2001; 12(3):589-597. DOI: 10.1681/ASN.V123589. View

Meier-Kriesche H, Port F, Ojo A, Rudich S, Hanson J, Cibrik D . Effect of waiting time on renal transplant outcome. Kidney Int. 2000; 58(3):1311-7. DOI: 10.1046/j.1523-1755.2000.00287.x. View

Cassuto J, Patel S, Tsoulfas G, Orloff M, Abt P . The cumulative effects of cold ischemic time and older donor age on liver graft survival. J Surg Res. 2008; 148(1):38-44. DOI: 10.1016/j.jss.2008.03.018. View

Shao M, Ye Q, Ming Y, She X, Liu H, Ye S . Risk factors for delayed graft function in cardiac death donor renal transplants. Chin Med J (Engl). 2012; 125(21):3782-5. View

10.

Mange K, Joffe M, Feldman H . Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors. N Engl J Med. 2001; 344(10):726-31. DOI: 10.1056/NEJM200103083441004. View

11.

Johnson S, Alexopoulos S, Curry M, Hanto D . Primary nonfunction (PNF) in the MELD Era: An SRTR database analysis. Am J Transplant. 2007; 7(4):1003-9. DOI: 10.1111/j.1600-6143.2006.01702.x. View

12.

Marino I, Doyle H, Aldrighetti L, Doria C, McMichael J, Gayowski T . Effect of donor age and sex on the outcome of liver transplantation. Hepatology. 1995; 22(6):1754-62. PMC: 2965620. View

13.

Ojo A, Wolfe R, Held P, Port F, Schmouder R . Delayed graft function: risk factors and implications for renal allograft survival. Transplantation. 1997; 63(7):968-74. DOI: 10.1097/00007890-199704150-00011. View

14.

Doshi M, Hunsicker L . Short- and long-term outcomes with the use of kidneys and livers donated after cardiac death. Am J Transplant. 2006; 7(1):122-9. DOI: 10.1111/j.1600-6143.2006.01587.x. View

15.

Hetzel G, Klein B, Brause M, Westhoff A, Willers R, Sandmann W . Risk factors for delayed graft function after renal transplantation and their significance for long-term clinical outcome. Transpl Int. 2002; 15(1):10-6. DOI: 10.1007/s00147-001-0368-7. View

16.

Hoofnagle J, Lombardero M, Zetterman R, Lake J, Porayko M, Everhart J . Donor age and outcome of liver transplantation. Hepatology. 1996; 24(1):89-96. DOI: 10.1002/hep.510240116. View

17.

Butkus D, Meydrech E, Raju S . Racial differences in the survival of cadaveric renal allografts. Overriding effects of HLA matching and socioeconomic factors. N Engl J Med. 1992; 327(12):840-5. DOI: 10.1056/NEJM199209173271203. View

18.

Lynch R, Mathur A, Hundley J, Kubus J, Pietroski R, Mattice B . Improving organ procurement practices in Michigan. Am J Transplant. 2009; 9(10):2416-23. PMC: 4559330. DOI: 10.1111/j.1600-6143.2009.02784.x. View

19.

Cicciarelli J, Iwaki Y, Mendez R . The influence of donor age on kidney graft survival in the 1990s. Clin Transpl. 2000; :335-40. View

20.

Kuo P, Johnson L, Schweitzer E, Alfrey E, Waskerwitz J, Bartlett S . Utilization of the older donor for renal transplantation. Am J Surg. 1996; 172(5):551-5; discussion 556-7. DOI: 10.1016/S0002-9610(96)00233-4. View