Effects of ischemic time in living-donor kidney transplantation: a retrospective, propensity score-matched cohort...

Kidneys are relatively resistant to ischemia. Few studies have examined the effects of short ischemic time in living-donor kidney transplantation. This retrospective study investigated the effects of ischemic time on renal function in living-donor kidney transplantation.

Patients who have undergone kidney transplantation in Kyushu University Hospital between January 2017 and December 2021 were divided into two groups based on the median ischemic time (< 170 min and ≥ 170 min), after propensity score matching. A multivariate analysis was performed to determine the risk factors for renal dysfunction.

Each group contained 89 patients. Shorter ischemic time (< 170 min) was associated with higher postoperative glomerular filtration rates during the first-seventh postoperative days (POD7, 48.8 ± 18.9 vs. 42.8 ± 20.5; p = 0.04). Donor sex (female, odds ratio [OR]: 2.53, 95% confidence interval [CI] 1.11-5.82, p = 0.028), donor age (≥ 50 years, OR: 18.7, 95% CI 8.51-41.1, p < 0.001), diabetes (OR: 3.01, 95% CI 1.17-7.77, p = 0.023), and acute rejection within 1 year (OR: 17.3, 95% CI 2.02-148.2, p = 0.009) significantly increased renal dysfunction risk at 1 year. Ischemic time was not related to renal dysfunction 1 year after kidney transplantation (ischemic time ≥ 170 min, OR 1.06, 95% CI [0.52-2.14]; p = 0.88). The OR for an ischemic time ≥ 170 min was 0.69 (95% CI 0.27-1.75) in donors aged < 50 and 1.70 (95% CI: 0.63-4.60) in those aged ≥ 50 years (interaction p = 0.13).

Longer ischemic time was correlated with early postoperative renal dysfunction, although the effect on renal function at 1 year was minimal with short ischemic times. Adverse effects of ischemic time on renal function after 1 year should be considered with older donors.