Graft survival after kidney transplantation with standard versus prolonged kidney procurement time

Background: During kidney procurement, after ice removal, kidneys located in the retroperitoneum are at risk for rewarming owing to the time taken to retrieve other abdominal and thoracic organs, which may lead to poorer outcomes. The purpose of this study was to evaluate the impact of prolonged kidney procurement time (PKP) on outcomes of kidney transplantation performed at the Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada. Methods: We retrospectively reviewed the cases of all adult (age >= 18 yr) patients who underwent kidney transplantation at the Queen Elizabeth II Health Sciences Centre between Jan. 1, 2010, and Dec. 31, 2015. We included all patients who received kidney transplants from deceased donors with a minimum follow-up period of 3 years. We defined PKP as more than 65 minutes from aortic cross-clamp to final organ extraction, and standard procurement time (SP) as 65 minutes or less. Results: Among the 455 transplantation procedures performed during the study period, we reviewed the cases of 145 patients who received kidneys from Nova Scotian donors and were followed in Nova Scotia. No statistically significant differences were seen in outcomes between kidney-only (n = 46) and multiorgan (n = 99) procurement, although more organs from kidney-only donors than multiorgan donors had a Kidney Donor Profile Index score greater than 50% (32 [69.6%] v. 48 [48.5%], p < 0.01). Compared to the SP group (n = 115), the PKP group (n = 30) had a higher rate of 30-day graft loss (6.7% v. 0.0%, p < 0.01), a higher incidence of de novo formation of donor-specific antibodies (3 [10.0%] v. 1 [0.9%], p < 0.01) and a lower 5-year graft survival rate (90.0% v. 97.4%, p = 0.03). Left kidneys remained 11 minutes longer on the donor than right kidneys when multiorgan procurement was performed (p < 0.01), and their 5-year survival rate was significantly lower than that of right kidneys (p = 0.03). Conclusion: Procurement times longer than 65 minutes may be associated with poorer outcomes after kidney transplantation. Measures to reduce kidney exposure to rewarming during procurement may improve long-term outcomes. Contexte: Au cours du prelevement de greffons renaux, apres l'extraction de la glace, les reins situes dans le retroperitoine risquent de se rechauffer en raison du temps necessaire au prelevement d'autres organes abdominaux et thoraciques, ce qui peut entrainer des consequences moins favorables. L'objectif de cette etude etait d'evaluer l'effet d'un temps de prelevement renal prolonge (PRP) sur les resultats des transplantations renales realisees au Queen Elizabeth II Health Sciences Centre, a Halifax (N.-E., Canada). Methodes: Nous avons procede a une analyse retrospective des dossiers de tous les patients adultes (age >= 18 ans) qui ont subi une transplantation renale au Queen Elizabeth II Health Sciences Centre, entre le 1(er) janvier 2010 et le 31 decembre 2015. Nous avons inclus tous les patients qui ont recu des reins provenant de donneurs decedes dont le suivi se deroulait depuis au moins 3 ans. Nous avons defini le temps de PRP a plus de 65 minutes, du clampage de l'aorte a l'extraction du dernier organe, et le temps de prelevement standard (PS) a 65 minutes ou moins. Resultats: Parmi les 455 interventions realisees pendant la periode de l'etude, nous avons examine les dossiers medicaux de 145 patients qui ont recu des reins de donneurs provenant de la Nouvelle-Ecosse et qui etaient suivis en Nouvelle-Ecosse. Il n'y avait aucune difference statistiquement significative entre les prelevements renaux uniques (n = 46) et les prelevements d'organes multiples (n = 99), bien qu'un nombre plus eleve de donneurs de reins uniques que de donneurs d'organes multiples presentaient un score au Kidney Donor Profile Index superieur a 50 % (32 [69,6 %] contre 48 [48,5 %], p < 0,01). Comparativement au groupe de PS (n = 115), le groupe de PRP (n = 30) presentait un taux superieur de perte du greffon a 30 jours (6,7 % contre 0,0 %, p < 0,01), une incidence accrue de formation recurrente d'anticorps specifiques au donneur (3 [10,0 %] contre 1 [0,9 %], p < 0,01) et un plus faible taux de survie du greffon a 5 ans (90,0 % contre 97,4 %, p = 0,03). Lors des prelevements d'organes multiples, les reins gauches sont demeures 11 minutes de plus dans le donneur que les reins droits (p < 0,01) et leur survie a 5 ans etait significativement inferieure a celle des reins droits (p = 0,03). Conclusion: Les temps de prelevement superieurs a 65 minutes peuvent etre associes a des resultats moins favorables apres la transplantation renale. La prise de mesures pour diminuer l'exposition des reins au rechauffement pendant le prelevement pourrait ameliorer les resultats a long terme.