Related Experiment Video
Updated: Oct 17, 2025
Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
Timing of Kidney Clamping and Deceased Donor Kidney Transplant Outcomes
Simon Ville1, Marine Lorent2, Clarisse Kerleau2
1Institut de Transplantation Urologie Néphrologie, CHU Nantes, Nantes, France.
Background And Objectives:
The fact that metabolism and immune function are regulated by an endogenous molecular clock that generates circadian rhythms suggests that the magnitude of ischemia reperfusion, and subsequent inflammation on kidney transplantation, could be affected by the time of the day.
Design, Setting, Participants, & Measurements:
We evaluated 5026 individuals who received their first kidney transplant from deceased heart-beating donors. In a cause-specific multivariable analysis, we compared delayed graft function and graft survival according to the time of kidney clamping and declamping. Participants were divided into those clamped between midnight and noon (ante meridiem [am] clamping group; 65%) or clamped between noon and midnight (post meridiem [pm] clamping group; 35%), and, similarly, those who underwent am declamping (25%) or pm declamping (75%).
Results:
Delayed graft function occurred among 550 participants (27%) with am clamping and 339 (34%) with pm clamping (adjusted odds ratio, 0.81; 95% confidence interval, 0.67 to 0.98; P=0.03). No significant association was observed between clamping time and overall death-censored graft survival (hazard ratio, 0.92; 95% confidence interval, 0.77 to 1.10; P=0.37). No significant association of declamping time with delayed graft function or graft survival was observed.
Conclusions:
Clamping between midnight and noon was associated with a lower incidence of delayed graft function, whereas declamping time was not associated with kidney graft outcomes.
Insights
Kidney transplantation outcomes are influenced by the time of day. Clamping kidneys between midnight and noon, compared to noon and midnight, was associated with a reduced risk of delayed graft function.
Area of Science:
- Nephrology
- Immunology
- Chronobiology
Background:
- Circadian rhythms, regulated by an endogenous molecular clock, influence metabolism and immune function.
- This suggests that the timing of kidney transplantation could impact ischemia reperfusion and inflammation.
Purpose of the Study:
- To investigate the association between the time of kidney clamping and declamping and outcomes in kidney transplantation.
- Specifically, to evaluate the impact on delayed graft function and graft survival.
Main Methods:
- A cohort of 5026 first-time kidney transplant recipients from deceased heart-beating donors was analyzed.
- Participants were categorized based on kidney clamping time: midnight to noon (ante meridiem [am]) or noon to midnight (post meridiem [pm]).
- Cause-specific multivariable analysis compared delayed graft function and graft survival between groups.
Main Results:
- Delayed graft function occurred in 27% of the am clamping group versus 34% in the pm clamping group (adjusted odds ratio, 0.81; P=0.03).
- No significant association was found between clamping time and death-censored graft survival (hazard ratio, 0.92; P=0.37).
- Declamping time showed no significant association with delayed graft function or graft survival.
Conclusions:
- Kidney clamping between midnight and noon is linked to a lower incidence of delayed graft function.
- The time of declamping did not significantly affect kidney graft outcomes.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management