Y. GoldenMerry1, H. Piristine1, P. Prabhakar1, J. Parekh1, C. Hwang1, M. MacConmara1 1UT Southwestern Medical Center,Dallas, TX, USA
Introduction:
Many factors impact outcomes of transplant kidney allografts. There has been renewed interest in studying the effect of warm ischemia time during implantation on allograft outcomes. Longer anastomotic time leads to warming of the allograft, and organ temperature above 15 degrees Celsius at reperfusion has been shown to increase the risk of delayed graft function (DGF). DGF is risk factor for allograft loss and has been associated with a reduction in five-year allograft survival by up to 50%. We sought to investigate the perceived importance of anastomotic time amongst practicing kidney transplant surgeons and attitudes toward potential need for improvement in this component of the transplant process.
Methods:
Transplant surgeons were invited to complete an anonymous electronic questionnaire on their kidney transplant operative practices. Self-reported data on cold and warm ischemia time, percent of organ imports, total length of operation, percent of complex anastomotic procedures and anastomosis time were gathered. Opinions regarding the effect of warm ischemia time on DGF, current methods to combat organ warming, and receptiveness to new technology were also collected.
Results:
Surgeons at seven transplant centers across the US completed the survey. Average cold ischemia time (time from cross clamp until the time the organ was taken out of ice) at centers was 13.3+/-3.7 hours, import kidneys accounted for 12+/-7% of transplants, and 26+/-25% of all kidneys were placed on pulsatile perfusion prior to transplantation. The average operative time was 174+/-37 minutes, with anastomoses taking 30+/-5 minutes. Surgeons perceived that warm time was greater than goal in 25+/-21% of anastomoses. Seventy percent of surgeons agreed that warming during implantation contributes to negative graft outcomes (DGF), however 30% of responders did not employ any cooling and the remainder used an icy wrap or tried to irrigate with cold slush while performing the anastomosis. Eighty percent of surgeons indicated they would utilize a specific cooling device if available.
Conclusions:
Longer anastomotic time has been demonstrated to negatively affect kidney allograft function. Our data show that surgeons recognize the negative impact of warming during anastomoses especially in complex cases. Most surgeons do not use a specific strategy to keep the organ cool and would be very receptive to a dedicated cooling device.