American Journal of Transplantation vol:Ahead of print
Recent studies raise the concern that warm ischemia during the time to complete the 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 13964 recipients of solitary deceased-donor kidney transplants in the Eurotransplant region. Anastomosis time was independently associated with graft loss after adjusting for other risk factors (adjusted hazard rate 1.10 for every ten-minute increase, 95% confidence interval 1.06-1.14; P<0.0001), while it did not influence recipient survival (hazard rate 1.00, 95% confidence interval 0.97-1.02). Circulatory-dead donor (DCD) kidneys were less tolerant to prolonged anastomosis time than brain-dead donor kidneys (P for interaction=0.02). The additive effect of anastomosis time with donor warm ischemia time explains this observation, since DCD status was no longer associated with graft survival when adjusted for this sum warm ischemia time and there was no interaction between DCD status and sum warm ischemia time. Thus, the time to create the vascular anastomoses in kidney transplantation is associated with inferior transplant outcome, especially in recipients of DCD kidneys. This article is protected by copyright. All rights reserved.