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Purpose <p>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.</p> Methods <p>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 (&lt; 170&#xa0;min and ≥ 170&#xa0;min), after propensity score matching. A multivariate analysis was performed to determine the risk factors for renal dysfunction.</p> Results <p>Each group contained 89 patients. Shorter ischemic time (&lt; 170&#xa0;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; <i>p</i> = 0.04). Donor sex (female, odds ratio [OR]: 2.53, 95% confidence interval [CI] 1.11–5.82, <i>p</i> = 0.028), donor age (≥ 50&#xa0;years, OR: 18.7, 95% CI 8.51–41.1, <i>p</i> &lt; 0.001), diabetes (OR: 3.01, 95% CI 1.17–7.77, <i>p</i> = 0.023), and acute rejection within 1&#xa0;year (OR: 17.3, 95% CI 2.02–148.2, <i>p</i> = 0.009) significantly increased renal dysfunction risk at 1&#xa0;year. Ischemic time was not related to renal dysfunction 1&#xa0;year after kidney transplantation (ischemic time ≥ 170&#xa0;min, OR 1.06, 95% CI [0.52–2.14]; <i>p</i> = 0.88). The OR for an ischemic time ≥ 170&#xa0;min was 0.69 (95% CI 0.27–1.75) in donors aged &lt; 50 and 1.70 (95% CI: 0.63–4.60) in those aged ≥ 50&#xa0;years (interaction <i>p</i> = 0.13).</p> Conclusions <p>Longer ischemic time was correlated with early postoperative renal dysfunction, although the effect on renal function at 1&#xa0;year was minimal with short ischemic times. Adverse effects of ischemic time on renal function after 1&#xa0;year should be considered with older donors.</p>

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

  • 期刊论文

  • 发表日期：

    2025年10月22日

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  • Shinnosuke Takamori,
  • Kazuhiro Shirozu,
  • Jun Maki,
  • Keizo Kaku,
  • Yuri Nakamura,
  • Tomohiko Akahoshi,
  • Ken Yamaura

摘要

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.