Prolonged Cold Ischemia Time Offsets the Benefit of Human Leukocyte Antigen Matching in Deceased Donor Kidney Transplant.
Journal
Transplantation proceedings
ISSN: 1873-2623
Titre abrégé: Transplant Proc
Pays: United States
ID NLM: 0243532
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
received:
20
11
2019
accepted:
15
12
2019
pubmed:
24
2
2020
medline:
17
9
2020
entrez:
24
2
2020
Statut:
ppublish
Résumé
The consequences of prolonging cold ischemia time (CIT) to facilitate HLA matching in kidney transplantation are not known. Patients with a history of kidney transplant in the United States (2000-2016) with 0 HLA mismatch (MM) were categorized based on CIT (< 10; 10 to < 15; 15 to < 20; 20 to < 25; 25 to < 30; and ≥ 30 hours). Time to graft loss was compared for each CIT category to a reference group of individuals with > 0 HLA MM and short CIT (< 10 hours) using a multivariable Cox proportional hazards model. The adjusted risk of graft failure was significantly lower for 0 HLA MM with the shortest CIT compared to the reference group (hazard ratio, 0.82; 95% confidence interval, 0.72-0.94), and this survival advantage persisted to a threshold of < 20 hours of CIT. No survival advantage was observed for the 0 HLA MM group once CIT was > 20 hours. This trend persisted after excluding highly sensitized recipients (panel reactive antibody > 98%) where shipping of organs occurs to achieve more equitable access to organs rather than optimize HLA match. CIT > 20 hours offsets the benefit of 0 HLA MM in kidney transplantation. This may have implications in organ shipping to facilitate immunologic match.
Sections du résumé
BACKGROUND
BACKGROUND
The consequences of prolonging cold ischemia time (CIT) to facilitate HLA matching in kidney transplantation are not known.
METHODS
METHODS
Patients with a history of kidney transplant in the United States (2000-2016) with 0 HLA mismatch (MM) were categorized based on CIT (< 10; 10 to < 15; 15 to < 20; 20 to < 25; 25 to < 30; and ≥ 30 hours). Time to graft loss was compared for each CIT category to a reference group of individuals with > 0 HLA MM and short CIT (< 10 hours) using a multivariable Cox proportional hazards model.
RESULTS
RESULTS
The adjusted risk of graft failure was significantly lower for 0 HLA MM with the shortest CIT compared to the reference group (hazard ratio, 0.82; 95% confidence interval, 0.72-0.94), and this survival advantage persisted to a threshold of < 20 hours of CIT. No survival advantage was observed for the 0 HLA MM group once CIT was > 20 hours. This trend persisted after excluding highly sensitized recipients (panel reactive antibody > 98%) where shipping of organs occurs to achieve more equitable access to organs rather than optimize HLA match.
CONCLUSIONS
CONCLUSIONS
CIT > 20 hours offsets the benefit of 0 HLA MM in kidney transplantation. This may have implications in organ shipping to facilitate immunologic match.
Identifiants
pubmed: 32088062
pii: S0041-1345(19)31612-4
doi: 10.1016/j.transproceed.2019.12.049
pii:
doi:
Substances chimiques
HLA Antigens
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
807-814Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.