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Effect of donor nephrectomy time during circulatory‐dead donor kidney retrieval on transplant graft failure.

Published: 1st October 2019

Authors: L. Heylen, J. Pirenne, U. Samuel, I. Tieken, M. Coemans, M. Naesens et al.

Background

When the blood supply ceases in a deceased organ donor, ischaemic injury starts. Kidneys are cooled to reduce cellular metabolism and minimize ischaemic injury. This cooling is slow and kidneys are lukewarm during nephrectomy. Smaller single‐centre studies have shown that prolonged donor nephrectomy time decreases early kidney transplant function, but the effect on long‐term outcome has never been investigated in large multicentre cohort studies.

Method

The relationship between donor nephrectomy time and death‐censored graft survival was evaluated in recipients of single adult‐to‐adult, first‐time deceased‐donor kidneys transplanted in the Eurotransplant region between 2004 and 2013.

Results

A total of 13 914 recipients were included. Median donor nephrectomy time was 51 (i.q.r. 39–65) min. Kidneys donated after circulatory death had longer nephrectomy times than those from brain‐dead donors: median 57 (43–78) versus 50 (39–64) min respectively (P < 0·001). Donor nephrectomy time was independently associated with graft loss when kidneys were donated after circulatory death: adjusted hazard ratio (HR) 1·05 (95 per cent c.i. 1·01 to 1·09) per 10‐min increase (P = 0·026). The magnitude of this effect was comparable to the effect of each hour of additional cold ischaemia: HR 1·04 (1·01 to 1·07) per h (P = 0·004). For kidneys donated after brain death, there was no effect of nephrectomy time on graft survival: adjusted HR 1·01 (0·98 to 1·04) per 10 min (P = 0·464).

Conclusion

Prolonged donor nephrectomy time impairs graft outcome in kidneys donated after circulatory death. Keeping this short, together with efficient cooling during nephrectomy, might improve outcome.

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