Prolonged organ extraction time negatively impacts kidney transplantation outcome

H. Maassen, C. Moers, H. van Goor, H.G.D. Leuvenink, H.S. Hofker

Wednesday 4 march 2020

17:20 - 17:30h at Theaterzaal

Parallel session: Parallel sessie VI – Klinische abstracts

Background: During a deceased donation procedure, organs are flushed with cold fluid before retrieval, to reduce metabolism and preserve organ quality. However, the intended 0-4°C are never reached and kidneys stay around 18°C and ischemic during the procurement surgery. A prolonged organ extraction time could therefore have a detrimental influence on transplantation outcome.

Methods: We analyzed data from 5426 multicenter transplant procedures from the Dutch Organ Transplantation Registry, performed between 01-2002 and 12-2016. Extraction time was defined as start of the cold aortic flush until end of nephrectomy. Extraction times shorter than 5 minutes or longer than 5 hours where excluded. We studied the association between extraction time, patient survival, graft survival and delayed graft function (DGF). Analysis was performed on those cases for which both extraction time and outcome were known, using multivariable Cox regression or binary logistic regression, where appropriate.

Results: Median kidney extraction time was 58 minutes. Extraction time was independently associated with graft loss (HR 1.025 [1.002-1.048]; P=0.036) and with delayed graft function (OR 1.040 [1.017-1.063]; P=0.001) for every 10 minutes increase, but not with patient survival (HR 1.001 [0.983-1.019]; P=0.922). An extraction time above 80 minutes was associated with a 23.7% higher risk of graft failure (4.6-46.3%; P=0.013) and those kidneys with an extraction time above 70 minutes had 22.0% higher odds of developing DGF (6.0-40.4%; P=0.005).

Conclusions: Prolonged extraction time significantly influences graft survival and DGF. New strategies may be required to achieve better organ preservation during kidney retrieval.