[HTML][HTML] Day-time declamping is associated with better outcomes in kidney transplantation: the circarein study

D Montaigne, N Alhawajri, M Jacquelinet… - Journal of Clinical …, 2021 - mdpi.com
D Montaigne, N Alhawajri, M Jacquelinet, A Coppin, M Frimat, S Bouye, G Lebuffe, B Staels
Journal of Clinical Medicine, 2021mdpi.com
Despite improvements in organ preservation techniques and efforts to minimize the duration
of cold ischemia, ischemia–reperfusion (IR) injury remains associated with poor graft
function and long-term survival in kidney transplantation. We recently demonstrated a
clinically significant day-time variation in myocardial tolerance to IR, transcriptionally
orchestrated by the circadian clock. Patient and graft post-transplant survival were studied in
a cohort of 10,291 patients first transplanted between 2006 and 2017 to test whether kidney …
Despite improvements in organ preservation techniques and efforts to minimize the duration of cold ischemia, ischemia–reperfusion (IR) injury remains associated with poor graft function and long-term survival in kidney transplantation. We recently demonstrated a clinically significant day-time variation in myocardial tolerance to IR, transcriptionally orchestrated by the circadian clock. Patient and graft post-transplant survival were studied in a cohort of 10,291 patients first transplanted between 2006 and 2017 to test whether kidney graft tolerance to IR depends on the time-of-the-day of clamping/declamping, and thus impacts graft and patient survival. Post-transplant 1- and 3-year survival decreased with increasing ischemia duration. Time-of-the-day of clamping did not influence outcomes. However, night-time (vs. day-time) declamping was associated with a significantly worse post-transplant survival. After adjustment for other predictors, night-time (vs. day-time) declamping remained associated with a worse 1-year (HR = 1.26 (1.08–1.47), p = 0.0028 by Cox multivariable analysis) and 3-year (HR = 1.14 (1.02–1.27), p = 0.021) outcome. Interestingly, the deleterious impact of prolonged ischemia time (>15 h) was partially compensated by day-time (vs. night-time) declamping. Compared to night-time declamping, day-time declamping was associated with a better prognosis of kidney transplantation despite a longer duration of cold ischemia.
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