Effect of donor age and cold storage time on outcome in recipients of kidneys donated after circulatory death in the UK: a cohort study

Summary Background Use of kidneys donated after controlled circulatory death has increased the number of transplants undertaken in the UK but there remains reluctance to use kidneys from older circulatory-death donors and concern that kidneys from circulatory-death donors are particularly susceptibl...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:The Lancet (British edition) 2013-03, Vol.381 (9868), p.727-734
Hauptverfasser: Summers, Dominic M, MBBChir, Johnson, Rachel J, MSc, Hudson, Alex, MSc, Collett, David, Prof, Watson, Christopher J, Prof, Bradley, J Andrew, Prof
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 734
container_issue 9868
container_start_page 727
container_title The Lancet (British edition)
container_volume 381
creator Summers, Dominic M, MBBChir
Johnson, Rachel J, MSc
Hudson, Alex, MSc
Collett, David, Prof
Watson, Christopher J, Prof
Bradley, J Andrew, Prof
description Summary Background Use of kidneys donated after controlled circulatory death has increased the number of transplants undertaken in the UK but there remains reluctance to use kidneys from older circulatory-death donors and concern that kidneys from circulatory-death donors are particularly susceptible to cold ischaemic injury. We aimed to compare the effect of donor age and cold ischaemic time on transplant outcome in kidneys donated after circulatory death versus brain death. Methods We used the UK transplant registry to select a cohort of first-time recipients (aged ≥18 years) of deceased-donor kidneys for transplantations done between Jan 1, 2005, and Nov 1, 2010. We did univariate comparisons of transplants from brain-death donors versus circulatory-death donors with χ2 tests for categorical data and Wilcoxon tests for non-parametric continuous data. We used Kaplan-Meier curves to show graft survival. We used Cox proportional hazards regression to adjust for donor and recipient factors associated with graft-survival with tests for interaction effects to establish the relative effect of donor age and cold ischaemia on kidneys from circulatory-death and brain-death donors. Findings 6490 deceased-donor kidney transplants were done at 23 centres. 3 year graft survival showed no difference between circulatory-death (n=1768) and brain-death (n=4127) groups (HR 1·14, 95% CI 0·95–1·36, p=0·16). Donor age older than 60 years (compared with
doi_str_mv 10.1016/S0140-6736(12)61685-7
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1316054150</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0140673612616857</els_id><sourcerecordid>1316054150</sourcerecordid><originalsourceid>FETCH-LOGICAL-c554t-5c244b3859c2f4e7ca1dbedcf7b49abaa68a42cdcf1b8a182c772ca45eb8e7893</originalsourceid><addsrcrecordid>eNqFkc1u1DAUhSMEokPhEQBLCKksArZjxwkLEKrKj6jEoozEzrqxbzpuM_HUdpDmCXhtnJmhlbphZcv6zrnH9xTFc0bfMsrqdxeUCVrWqqpPGH9Ts7qRpXpQLJhQopRC_XpYLG6Ro-JJjFeUUlFT-bg44hWvGRP1ovhz1vdoEvE9sX70gcAlEhgtMX6wJCYf5ofk1kj8SPyUjM9XN5KAxm0cjinO2mtnR9zG2QMSWgJ9wkCMC2YaIJtsiUVIq1mYVkiW398TyCNWPqQ8ZLLbp8WjHoaIzw7ncbH8fPbz9Gt5_uPLt9NP56WRUqRSGi5EVzWyNbwXqAww26E1vepECx1A3YDgJj-wrgHWcKMUNyAkdg2qpq2Oi5O97yb4mwlj0msXDQ4DjOinqFnF8ooEkzSjr-6hV34KY043Uy1nUtUyU3JPmeBjDNjrTXBrCFvNqJ6b0rum9FyDZlzvmtIq614c3KdujfZW9a-aDLw-ABANDH2A0bh4xylaM1XNAV7uuR68hsuQmeUFp_kHlPG2lVUmPu4JzIv97TDoaHJzBq3LLSZtvftv2A_3HMzgRpdjXeMW491edOSa7k1mD8Z3Dqr6C-eYzso</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1319215765</pqid></control><display><type>article</type><title>Effect of donor age and cold storage time on outcome in recipients of kidneys donated after circulatory death in the UK: a cohort study</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Summers, Dominic M, MBBChir ; Johnson, Rachel J, MSc ; Hudson, Alex, MSc ; Collett, David, Prof ; Watson, Christopher J, Prof ; Bradley, J Andrew, Prof</creator><creatorcontrib>Summers, Dominic M, MBBChir ; Johnson, Rachel J, MSc ; Hudson, Alex, MSc ; Collett, David, Prof ; Watson, Christopher J, Prof ; Bradley, J Andrew, Prof</creatorcontrib><description>Summary Background Use of kidneys donated after controlled circulatory death has increased the number of transplants undertaken in the UK but there remains reluctance to use kidneys from older circulatory-death donors and concern that kidneys from circulatory-death donors are particularly susceptible to cold ischaemic injury. We aimed to compare the effect of donor age and cold ischaemic time on transplant outcome in kidneys donated after circulatory death versus brain death. Methods We used the UK transplant registry to select a cohort of first-time recipients (aged ≥18 years) of deceased-donor kidneys for transplantations done between Jan 1, 2005, and Nov 1, 2010. We did univariate comparisons of transplants from brain-death donors versus circulatory-death donors with χ2 tests for categorical data and Wilcoxon tests for non-parametric continuous data. We used Kaplan-Meier curves to show graft survival. We used Cox proportional hazards regression to adjust for donor and recipient factors associated with graft-survival with tests for interaction effects to establish the relative effect of donor age and cold ischaemia on kidneys from circulatory-death and brain-death donors. Findings 6490 deceased-donor kidney transplants were done at 23 centres. 3 year graft survival showed no difference between circulatory-death (n=1768) and brain-death (n=4127) groups (HR 1·14, 95% CI 0·95–1·36, p=0·16). Donor age older than 60 years (compared with &lt;40 years) was associated with an increased risk of graft loss for all deceased-donor kidneys (2·35, 1·85–3·00, p&lt;0·0001) but there was no increased risk of graft loss for circulatory-death donors older than 60 years compared with brain-death donors in the same age group (p=0·30). Prolonged cold ischaemic time (&gt;24 h vs &lt;12 h) was not associated with decreased graft survival for all deceased-donor kidneys but was associated with poorer graft survival for kidneys from circulatory-death donors than for those from brain-death donors (2·36, 1·39–4·02, p for interaction=0·004). Interpretation Kidneys from older circulatory-death donors have equivalent graft survival to kidneys from brain-death donors in the same age group, and are acceptable for transplantation. However, circulatory-death donor kidneys tolerate cold storage less well than do brain-death donor kidneys and this finding should be considered when developing organ allocation policy. Funding UK National Health Service Blood and Transplant; Cambridge National Institute for Health Research Biomedical Research Centre.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(12)61685-7</identifier><identifier>PMID: 23261146</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Adult ; Age ; Age Factors ; Biological and medical sciences ; biomedical research ; blood ; Blood &amp; organ donations ; Brain ; Brain Death ; Cause of Death ; Chi-Square Distribution ; cohort studies ; cold ; cold storage ; Cold Temperature ; death ; Female ; General aspects ; Graft Survival ; Humans ; Internal Medicine ; ischemia ; issues and policy ; Kaplan-Meier Estimate ; kidney transplant ; Kidney transplantation ; Kidney Transplantation - methods ; kidneys ; Male ; Medical sciences ; Middle Aged ; Miscellaneous ; Mortality ; Organ Preservation - methods ; Proportional Hazards Models ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Retrospective Studies ; risk ; Statistics, Nonparametric ; storage time ; Survival ; Time Factors ; Tissue Donors ; Tissue Survival ; Transplants &amp; implants ; United Kingdom</subject><ispartof>The Lancet (British edition), 2013-03, Vol.381 (9868), p.727-734</ispartof><rights>Elsevier Ltd</rights><rights>2013 Elsevier Ltd</rights><rights>2014 INIST-CNRS</rights><rights>Copyright © 2013 Elsevier Ltd. All rights reserved.</rights><rights>Copyright Elsevier Limited Mar 2, 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c554t-5c244b3859c2f4e7ca1dbedcf7b49abaa68a42cdcf1b8a182c772ca45eb8e7893</citedby><cites>FETCH-LOGICAL-c554t-5c244b3859c2f4e7ca1dbedcf7b49abaa68a42cdcf1b8a182c772ca45eb8e7893</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0140673612616857$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=27061735$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23261146$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Summers, Dominic M, MBBChir</creatorcontrib><creatorcontrib>Johnson, Rachel J, MSc</creatorcontrib><creatorcontrib>Hudson, Alex, MSc</creatorcontrib><creatorcontrib>Collett, David, Prof</creatorcontrib><creatorcontrib>Watson, Christopher J, Prof</creatorcontrib><creatorcontrib>Bradley, J Andrew, Prof</creatorcontrib><title>Effect of donor age and cold storage time on outcome in recipients of kidneys donated after circulatory death in the UK: a cohort study</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Summary Background Use of kidneys donated after controlled circulatory death has increased the number of transplants undertaken in the UK but there remains reluctance to use kidneys from older circulatory-death donors and concern that kidneys from circulatory-death donors are particularly susceptible to cold ischaemic injury. We aimed to compare the effect of donor age and cold ischaemic time on transplant outcome in kidneys donated after circulatory death versus brain death. Methods We used the UK transplant registry to select a cohort of first-time recipients (aged ≥18 years) of deceased-donor kidneys for transplantations done between Jan 1, 2005, and Nov 1, 2010. We did univariate comparisons of transplants from brain-death donors versus circulatory-death donors with χ2 tests for categorical data and Wilcoxon tests for non-parametric continuous data. We used Kaplan-Meier curves to show graft survival. We used Cox proportional hazards regression to adjust for donor and recipient factors associated with graft-survival with tests for interaction effects to establish the relative effect of donor age and cold ischaemia on kidneys from circulatory-death and brain-death donors. Findings 6490 deceased-donor kidney transplants were done at 23 centres. 3 year graft survival showed no difference between circulatory-death (n=1768) and brain-death (n=4127) groups (HR 1·14, 95% CI 0·95–1·36, p=0·16). Donor age older than 60 years (compared with &lt;40 years) was associated with an increased risk of graft loss for all deceased-donor kidneys (2·35, 1·85–3·00, p&lt;0·0001) but there was no increased risk of graft loss for circulatory-death donors older than 60 years compared with brain-death donors in the same age group (p=0·30). Prolonged cold ischaemic time (&gt;24 h vs &lt;12 h) was not associated with decreased graft survival for all deceased-donor kidneys but was associated with poorer graft survival for kidneys from circulatory-death donors than for those from brain-death donors (2·36, 1·39–4·02, p for interaction=0·004). Interpretation Kidneys from older circulatory-death donors have equivalent graft survival to kidneys from brain-death donors in the same age group, and are acceptable for transplantation. However, circulatory-death donor kidneys tolerate cold storage less well than do brain-death donor kidneys and this finding should be considered when developing organ allocation policy. Funding UK National Health Service Blood and Transplant; Cambridge National Institute for Health Research Biomedical Research Centre.</description><subject>Adult</subject><subject>Age</subject><subject>Age Factors</subject><subject>Biological and medical sciences</subject><subject>biomedical research</subject><subject>blood</subject><subject>Blood &amp; organ donations</subject><subject>Brain</subject><subject>Brain Death</subject><subject>Cause of Death</subject><subject>Chi-Square Distribution</subject><subject>cohort studies</subject><subject>cold</subject><subject>cold storage</subject><subject>Cold Temperature</subject><subject>death</subject><subject>Female</subject><subject>General aspects</subject><subject>Graft Survival</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>ischemia</subject><subject>issues and policy</subject><subject>Kaplan-Meier Estimate</subject><subject>kidney transplant</subject><subject>Kidney transplantation</subject><subject>Kidney Transplantation - methods</subject><subject>kidneys</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>Mortality</subject><subject>Organ Preservation - methods</subject><subject>Proportional Hazards Models</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Retrospective Studies</subject><subject>risk</subject><subject>Statistics, Nonparametric</subject><subject>storage time</subject><subject>Survival</subject><subject>Time Factors</subject><subject>Tissue Donors</subject><subject>Tissue Survival</subject><subject>Transplants &amp; implants</subject><subject>United Kingdom</subject><issn>0140-6736</issn><issn>1474-547X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkc1u1DAUhSMEokPhEQBLCKksArZjxwkLEKrKj6jEoozEzrqxbzpuM_HUdpDmCXhtnJmhlbphZcv6zrnH9xTFc0bfMsrqdxeUCVrWqqpPGH9Ts7qRpXpQLJhQopRC_XpYLG6Ro-JJjFeUUlFT-bg44hWvGRP1ovhz1vdoEvE9sX70gcAlEhgtMX6wJCYf5ofk1kj8SPyUjM9XN5KAxm0cjinO2mtnR9zG2QMSWgJ9wkCMC2YaIJtsiUVIq1mYVkiW398TyCNWPqQ8ZLLbp8WjHoaIzw7ncbH8fPbz9Gt5_uPLt9NP56WRUqRSGi5EVzWyNbwXqAww26E1vepECx1A3YDgJj-wrgHWcKMUNyAkdg2qpq2Oi5O97yb4mwlj0msXDQ4DjOinqFnF8ooEkzSjr-6hV34KY043Uy1nUtUyU3JPmeBjDNjrTXBrCFvNqJ6b0rum9FyDZlzvmtIq614c3KdujfZW9a-aDLw-ABANDH2A0bh4xylaM1XNAV7uuR68hsuQmeUFp_kHlPG2lVUmPu4JzIv97TDoaHJzBq3LLSZtvftv2A_3HMzgRpdjXeMW491edOSa7k1mD8Z3Dqr6C-eYzso</recordid><startdate>20130302</startdate><enddate>20130302</enddate><creator>Summers, Dominic M, MBBChir</creator><creator>Johnson, Rachel J, MSc</creator><creator>Hudson, Alex, MSc</creator><creator>Collett, David, Prof</creator><creator>Watson, Christopher J, Prof</creator><creator>Bradley, J Andrew, Prof</creator><general>Elsevier Ltd</general><general>Elsevier</general><general>Elsevier Limited</general><scope>FBQ</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TT</scope><scope>0TZ</scope><scope>0U~</scope><scope>3V.</scope><scope>7QL</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88C</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8C1</scope><scope>8C2</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>KB~</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQGLB</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>20130302</creationdate><title>Effect of donor age and cold storage time on outcome in recipients of kidneys donated after circulatory death in the UK: a cohort study</title><author>Summers, Dominic M, MBBChir ; Johnson, Rachel J, MSc ; Hudson, Alex, MSc ; Collett, David, Prof ; Watson, Christopher J, Prof ; Bradley, J Andrew, Prof</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c554t-5c244b3859c2f4e7ca1dbedcf7b49abaa68a42cdcf1b8a182c772ca45eb8e7893</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Age</topic><topic>Age Factors</topic><topic>Biological and medical sciences</topic><topic>biomedical research</topic><topic>blood</topic><topic>Blood &amp; organ donations</topic><topic>Brain</topic><topic>Brain Death</topic><topic>Cause of Death</topic><topic>Chi-Square Distribution</topic><topic>cohort studies</topic><topic>cold</topic><topic>cold storage</topic><topic>Cold Temperature</topic><topic>death</topic><topic>Female</topic><topic>General aspects</topic><topic>Graft Survival</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>ischemia</topic><topic>issues and policy</topic><topic>Kaplan-Meier Estimate</topic><topic>kidney transplant</topic><topic>Kidney transplantation</topic><topic>Kidney Transplantation - methods</topic><topic>kidneys</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Miscellaneous</topic><topic>Mortality</topic><topic>Organ Preservation - methods</topic><topic>Proportional Hazards Models</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Retrospective Studies</topic><topic>risk</topic><topic>Statistics, Nonparametric</topic><topic>storage time</topic><topic>Survival</topic><topic>Time Factors</topic><topic>Tissue Donors</topic><topic>Tissue Survival</topic><topic>Transplants &amp; implants</topic><topic>United Kingdom</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Summers, Dominic M, MBBChir</creatorcontrib><creatorcontrib>Johnson, Rachel J, MSc</creatorcontrib><creatorcontrib>Hudson, Alex, MSc</creatorcontrib><creatorcontrib>Collett, David, Prof</creatorcontrib><creatorcontrib>Watson, Christopher J, Prof</creatorcontrib><creatorcontrib>Bradley, J Andrew, Prof</creatorcontrib><collection>AGRIS</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>News PRO</collection><collection>Pharma and Biotech Premium PRO</collection><collection>Global News &amp; ABI/Inform Professional</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium &amp; Calcified Tissue Abstracts</collection><collection>Nursing &amp; Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Biology Database (Alumni Edition)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Lancet Titles</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>eLibrary</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>ProQuest Newsstand Professional</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health &amp; Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health &amp; Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Applied &amp; Life Sciences</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>The Lancet (British edition)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Summers, Dominic M, MBBChir</au><au>Johnson, Rachel J, MSc</au><au>Hudson, Alex, MSc</au><au>Collett, David, Prof</au><au>Watson, Christopher J, Prof</au><au>Bradley, J Andrew, Prof</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of donor age and cold storage time on outcome in recipients of kidneys donated after circulatory death in the UK: a cohort study</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>2013-03-02</date><risdate>2013</risdate><volume>381</volume><issue>9868</issue><spage>727</spage><epage>734</epage><pages>727-734</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>Summary Background Use of kidneys donated after controlled circulatory death has increased the number of transplants undertaken in the UK but there remains reluctance to use kidneys from older circulatory-death donors and concern that kidneys from circulatory-death donors are particularly susceptible to cold ischaemic injury. We aimed to compare the effect of donor age and cold ischaemic time on transplant outcome in kidneys donated after circulatory death versus brain death. Methods We used the UK transplant registry to select a cohort of first-time recipients (aged ≥18 years) of deceased-donor kidneys for transplantations done between Jan 1, 2005, and Nov 1, 2010. We did univariate comparisons of transplants from brain-death donors versus circulatory-death donors with χ2 tests for categorical data and Wilcoxon tests for non-parametric continuous data. We used Kaplan-Meier curves to show graft survival. We used Cox proportional hazards regression to adjust for donor and recipient factors associated with graft-survival with tests for interaction effects to establish the relative effect of donor age and cold ischaemia on kidneys from circulatory-death and brain-death donors. Findings 6490 deceased-donor kidney transplants were done at 23 centres. 3 year graft survival showed no difference between circulatory-death (n=1768) and brain-death (n=4127) groups (HR 1·14, 95% CI 0·95–1·36, p=0·16). Donor age older than 60 years (compared with &lt;40 years) was associated with an increased risk of graft loss for all deceased-donor kidneys (2·35, 1·85–3·00, p&lt;0·0001) but there was no increased risk of graft loss for circulatory-death donors older than 60 years compared with brain-death donors in the same age group (p=0·30). Prolonged cold ischaemic time (&gt;24 h vs &lt;12 h) was not associated with decreased graft survival for all deceased-donor kidneys but was associated with poorer graft survival for kidneys from circulatory-death donors than for those from brain-death donors (2·36, 1·39–4·02, p for interaction=0·004). Interpretation Kidneys from older circulatory-death donors have equivalent graft survival to kidneys from brain-death donors in the same age group, and are acceptable for transplantation. However, circulatory-death donor kidneys tolerate cold storage less well than do brain-death donor kidneys and this finding should be considered when developing organ allocation policy. Funding UK National Health Service Blood and Transplant; Cambridge National Institute for Health Research Biomedical Research Centre.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>23261146</pmid><doi>10.1016/S0140-6736(12)61685-7</doi><tpages>8</tpages></addata></record>
fulltext fulltext
identifier ISSN: 0140-6736
ispartof The Lancet (British edition), 2013-03, Vol.381 (9868), p.727-734
issn 0140-6736
1474-547X
language eng
recordid cdi_proquest_miscellaneous_1316054150
source MEDLINE; Elsevier ScienceDirect Journals Complete
subjects Adult
Age
Age Factors
Biological and medical sciences
biomedical research
blood
Blood & organ donations
Brain
Brain Death
Cause of Death
Chi-Square Distribution
cohort studies
cold
cold storage
Cold Temperature
death
Female
General aspects
Graft Survival
Humans
Internal Medicine
ischemia
issues and policy
Kaplan-Meier Estimate
kidney transplant
Kidney transplantation
Kidney Transplantation - methods
kidneys
Male
Medical sciences
Middle Aged
Miscellaneous
Mortality
Organ Preservation - methods
Proportional Hazards Models
Public health. Hygiene
Public health. Hygiene-occupational medicine
Retrospective Studies
risk
Statistics, Nonparametric
storage time
Survival
Time Factors
Tissue Donors
Tissue Survival
Transplants & implants
United Kingdom
title Effect of donor age and cold storage time on outcome in recipients of kidneys donated after circulatory death in the UK: a cohort study
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-21T19%3A18%3A46IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Effect%20of%20donor%20age%20and%20cold%20storage%20time%20on%20outcome%20in%20recipients%20of%20kidneys%20donated%20after%20circulatory%20death%20in%20the%20UK:%20a%20cohort%20study&rft.jtitle=The%20Lancet%20(British%20edition)&rft.au=Summers,%20Dominic%20M,%20MBBChir&rft.date=2013-03-02&rft.volume=381&rft.issue=9868&rft.spage=727&rft.epage=734&rft.pages=727-734&rft.issn=0140-6736&rft.eissn=1474-547X&rft.coden=LANCAO&rft_id=info:doi/10.1016/S0140-6736(12)61685-7&rft_dat=%3Cproquest_cross%3E1316054150%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1319215765&rft_id=info:pmid/23261146&rft_els_id=1_s2_0_S0140673612616857&rfr_iscdi=true