Donor Death Category Is an Effect Modifier Between Cold Ischemia Time and Post-transplant Graft Function in Deceased-Donor Kidney Transplant Recipients

Objectives: We aimed to analyze the effect of cold ischemia time (CIT) on post-transplant graft function through mixed-effect model analysis to reduce the bias caused by paired mate kidneys.Methods: We reviewed all kidney transplantation records from 2015 to 2019 at our center. After applying the ex...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	You Luo, Zhanwen Dong, Xiao Hu, Zuofu Tang, Jinhua Zhang, Weiming Deng, Xiangling Wei, Bin Miao, Feng Qin, Ning Na
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	kidney transplantation cold ischemia time delayed graft function DCD DBD effect modification Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/e24e257df50e405981a1e6083fb7a50b
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:e24e257df50e405981a1e6083fb7a50b
record_format	dspace
spelling	oai:doaj.org-article:e24e257df50e405981a1e6083fb7a50b2021-11-30T12:25:44ZDonor Death Category Is an Effect Modifier Between Cold Ischemia Time and Post-transplant Graft Function in Deceased-Donor Kidney Transplant Recipients2296-858X10.3389/fmed.2021.743085https://doaj.org/article/e24e257df50e405981a1e6083fb7a50b2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.743085/fullhttps://doaj.org/toc/2296-858XObjectives: We aimed to analyze the effect of cold ischemia time (CIT) on post-transplant graft function through mixed-effect model analysis to reduce the bias caused by paired mate kidneys.Methods: We reviewed all kidney transplantation records from 2015 to 2019 at our center. After applying the exclusion criteria, 561 cases were included for analysis. All donor characteristics, preservation and matching information, and recipient characteristics were collected. Transplant outcomes included delayed graft function (DGF) and estimated glomerular filtration rate (eGFR). Generalized linear mixed models were applied for analysis. We also explored potential effect modifiers, namely, donor death category, expanded criteria donors, and donor death causes.Results: Among the 561 cases, 79 DGF recipients developed DGF, and 15 recipients who died after surgery were excluded from the eGFR estimation. The median stable eGFR of the 546 recipients was 60.39 (47.63, 76.97) ml/min/1.73 m2. After adjusting for confounding covariates, CIT had a negative impact on DGF incidence [odds ratio = 1.149 (1.006, 1.313), P = 0.041]. In the evaluation of the impact on eGFR, the regression showed that CIT had no significant correlation with eGFR [β = −0.287 (−0.625, 0.051), P = 0.096]. When exploring potential effect modifiers, only the death category showed a significant interaction with CIT in the effect on eGFR (Pinteraction = 0.027). In the donation after brain death (DBD) group, CIT had no significant effect on eGFR [β = 0.135 (−0.433, 0.702), P = 0.642]. In the donation after circulatory death/donation after brain death followed by circulatory death (DCD/DBCD) group, CIT had a significantly negative effect on eGFR [β= −0.700 (−1.196, −0.204), P = 0.006]. Compared to a CIT of 0–6 h, a CIT of 6–8 or 8–12 h did not decrease the post-transplant eGFR. CIT over 12 h (12–16 h or over 16 h) significantly decreased eGFR. With the increase in CIT, the regenerated eGFR worsened (Ptrend = 0.011).Conclusion: Considering the effect of paired mate kidneys, the risk of DGF increased with prolonged CIT. The donor death category was an effect modifier between CIT and eGFR. Prolonged CIT did not reduce the eGFR level in recipients from DBDs but significantly decreased the eGFR in recipients from DCDs/DBCDs. This result indicates the potential biological interaction between CIT and donor death category.You LuoZhanwen DongXiao HuZuofu TangJinhua ZhangJinhua ZhangWeiming DengXiangling WeiBin MiaoFeng QinNing NaFrontiers Media S.A.articlekidney transplantationcold ischemia timedelayed graft functionDCDDBDeffect modificationMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	kidney transplantation cold ischemia time delayed graft function DCD DBD effect modification Medicine (General) R5-920
spellingShingle	kidney transplantation cold ischemia time delayed graft function DCD DBD effect modification Medicine (General) R5-920 You Luo Zhanwen Dong Xiao Hu Zuofu Tang Jinhua Zhang Jinhua Zhang Weiming Deng Xiangling Wei Bin Miao Feng Qin Ning Na Donor Death Category Is an Effect Modifier Between Cold Ischemia Time and Post-transplant Graft Function in Deceased-Donor Kidney Transplant Recipients
description	Objectives: We aimed to analyze the effect of cold ischemia time (CIT) on post-transplant graft function through mixed-effect model analysis to reduce the bias caused by paired mate kidneys.Methods: We reviewed all kidney transplantation records from 2015 to 2019 at our center. After applying the exclusion criteria, 561 cases were included for analysis. All donor characteristics, preservation and matching information, and recipient characteristics were collected. Transplant outcomes included delayed graft function (DGF) and estimated glomerular filtration rate (eGFR). Generalized linear mixed models were applied for analysis. We also explored potential effect modifiers, namely, donor death category, expanded criteria donors, and donor death causes.Results: Among the 561 cases, 79 DGF recipients developed DGF, and 15 recipients who died after surgery were excluded from the eGFR estimation. The median stable eGFR of the 546 recipients was 60.39 (47.63, 76.97) ml/min/1.73 m2. After adjusting for confounding covariates, CIT had a negative impact on DGF incidence [odds ratio = 1.149 (1.006, 1.313), P = 0.041]. In the evaluation of the impact on eGFR, the regression showed that CIT had no significant correlation with eGFR [β = −0.287 (−0.625, 0.051), P = 0.096]. When exploring potential effect modifiers, only the death category showed a significant interaction with CIT in the effect on eGFR (Pinteraction = 0.027). In the donation after brain death (DBD) group, CIT had no significant effect on eGFR [β = 0.135 (−0.433, 0.702), P = 0.642]. In the donation after circulatory death/donation after brain death followed by circulatory death (DCD/DBCD) group, CIT had a significantly negative effect on eGFR [β= −0.700 (−1.196, −0.204), P = 0.006]. Compared to a CIT of 0–6 h, a CIT of 6–8 or 8–12 h did not decrease the post-transplant eGFR. CIT over 12 h (12–16 h or over 16 h) significantly decreased eGFR. With the increase in CIT, the regenerated eGFR worsened (Ptrend = 0.011).Conclusion: Considering the effect of paired mate kidneys, the risk of DGF increased with prolonged CIT. The donor death category was an effect modifier between CIT and eGFR. Prolonged CIT did not reduce the eGFR level in recipients from DBDs but significantly decreased the eGFR in recipients from DCDs/DBCDs. This result indicates the potential biological interaction between CIT and donor death category.
format	article
author	You Luo Zhanwen Dong Xiao Hu Zuofu Tang Jinhua Zhang Jinhua Zhang Weiming Deng Xiangling Wei Bin Miao Feng Qin Ning Na
author_facet	You Luo Zhanwen Dong Xiao Hu Zuofu Tang Jinhua Zhang Jinhua Zhang Weiming Deng Xiangling Wei Bin Miao Feng Qin Ning Na
author_sort	You Luo
title	Donor Death Category Is an Effect Modifier Between Cold Ischemia Time and Post-transplant Graft Function in Deceased-Donor Kidney Transplant Recipients
title_short	Donor Death Category Is an Effect Modifier Between Cold Ischemia Time and Post-transplant Graft Function in Deceased-Donor Kidney Transplant Recipients
title_full	Donor Death Category Is an Effect Modifier Between Cold Ischemia Time and Post-transplant Graft Function in Deceased-Donor Kidney Transplant Recipients
title_fullStr	Donor Death Category Is an Effect Modifier Between Cold Ischemia Time and Post-transplant Graft Function in Deceased-Donor Kidney Transplant Recipients
title_full_unstemmed	Donor Death Category Is an Effect Modifier Between Cold Ischemia Time and Post-transplant Graft Function in Deceased-Donor Kidney Transplant Recipients
title_sort	donor death category is an effect modifier between cold ischemia time and post-transplant graft function in deceased-donor kidney transplant recipients
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/e24e257df50e405981a1e6083fb7a50b
work_keys_str_mv	AT youluo donordeathcategoryisaneffectmodifierbetweencoldischemiatimeandposttransplantgraftfunctionindeceaseddonorkidneytransplantrecipients AT zhanwendong donordeathcategoryisaneffectmodifierbetweencoldischemiatimeandposttransplantgraftfunctionindeceaseddonorkidneytransplantrecipients AT xiaohu donordeathcategoryisaneffectmodifierbetweencoldischemiatimeandposttransplantgraftfunctionindeceaseddonorkidneytransplantrecipients AT zuofutang donordeathcategoryisaneffectmodifierbetweencoldischemiatimeandposttransplantgraftfunctionindeceaseddonorkidneytransplantrecipients AT jinhuazhang donordeathcategoryisaneffectmodifierbetweencoldischemiatimeandposttransplantgraftfunctionindeceaseddonorkidneytransplantrecipients AT jinhuazhang donordeathcategoryisaneffectmodifierbetweencoldischemiatimeandposttransplantgraftfunctionindeceaseddonorkidneytransplantrecipients AT weimingdeng donordeathcategoryisaneffectmodifierbetweencoldischemiatimeandposttransplantgraftfunctionindeceaseddonorkidneytransplantrecipients AT xianglingwei donordeathcategoryisaneffectmodifierbetweencoldischemiatimeandposttransplantgraftfunctionindeceaseddonorkidneytransplantrecipients AT binmiao donordeathcategoryisaneffectmodifierbetweencoldischemiatimeandposttransplantgraftfunctionindeceaseddonorkidneytransplantrecipients AT fengqin donordeathcategoryisaneffectmodifierbetweencoldischemiatimeandposttransplantgraftfunctionindeceaseddonorkidneytransplantrecipients AT ningna donordeathcategoryisaneffectmodifierbetweencoldischemiatimeandposttransplantgraftfunctionindeceaseddonorkidneytransplantrecipients
_version_	1718406657830027264

Donor Death Category Is an Effect Modifier Between Cold Ischemia Time and Post-transplant Graft Function in Deceased-Donor Kidney Transplant Recipients

Ejemplares similares