Urologic Survey (Transplantation)

Re: Prolonged Warm Ischemia Time is Associated With Graft Failure and Mortality After Kidney Transplantation

10.4274/jus.2016.02.015

  • Yarkin Kamil Yakupoglu

J Urol Surg 2016;3(2):56-56

EDITORIAL COMMENT

The effect of warm ischemia time (the time from organ removal from cold storage to reperfusion with warm blood) on death and graft survival was investigated on a very large cohort of kidney recipients consisting of 131677 patients with 35901 events (20032 graft failures and 15869 deaths) over a 13-year period by using the data from the Scientific Registry of Transplant Recipients. Therefore, the 10-to-under-20 minute interval was chosen as the reference group. For each increment of 10 minutes of warm ischemia time was associated with an increased risk of death and graft failure. Interestingly, it was reported that after stratification by donor type (living vs. deceased donor) and delayed graft function status, the association between prolonged warm ischemia time and death/graft failure persisted. Longer times may be inevitable for some surgeries depending on the given donor and recipient factors even for the same surgeon. It is still not clear whether there is an ideal time below which there is no effect, however, strategies to reduce warm ischemia time like increasing surgical skills in simulation laboratories in order to achieve anastomosis times less than 30-35 minutes should be encouraged. In addition, better documentation of warm ischemia during surgery might help predict the future outcomes.