1. Timing of Kidney Clamping and Deceased Donor Kidney Transplant Outcomes
- Author
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Simon, Ville, Marine, Lorent, Clarisse, Kerleau, Anders, Asberg, Christophe, Legendre, Emmanuel, Morelon, Fanny, Buron, Valérie, Garrigue, Moglie, Le Quintrec, Sophie, Girerd, Marc, Ladrière, Laetitia, Albano, Antoine, Sicard, Denis, Glotz, Carmen, Lefaucheur, Julien, Branchereau, David, Jacobi, Magali, Giral, Etienne, Sicard, Institut de Transplantation et de Recherche en Transplantation [CHU Nantes] (ITERT), Centre hospitalier universitaire de Nantes (CHU Nantes), European cohort for Kidney Transplantation Epidemiology (EKiTE), Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology (U1064 Inserm - CR2TI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ), Oslo University Hospital [Oslo], Réseau CENTAURE, Service Néphrologie et transplantation rénale Adultes [CHU Necker], CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital Lapeyronie [Montpellier] (CHU), Service de Néphrologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Département de Néphrologie - Hôpital Pasteur [Nice], Hôpital Pasteur [Nice] (CHU), Service d'Urologie [CHU Saint-Louis], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Institut de transplantation urologie-néphrologie (ITUN), Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes), unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE), and Salvy-Córdoba, Nathalie
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Graft Rejection ,Male ,Time Factors ,Databases, Factual ,Epidemiology ,Kidney ,Critical Care and Intensive Care Medicine ,[SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,Organ transplantation ,MESH: Kidney Transplantation ,MESH: Delayed Graft Function ,Kidney transplantation / nephrology ,MESH: Incidence ,Prospective Studies ,Kidney transplantation ,MESH: Aged ,MESH: Middle Aged ,Norway ,Ischemia-reperfusion ,Incidence ,Graft Survival ,Hazard ratio ,Middle Aged ,Constriction ,medicine.anatomical_structure ,Nephrology ,Cardiology ,Female ,France ,Adult ,medicine.medical_specialty ,MESH: Circadian Clocks ,MESH: Graft Survival ,Delayed Graft Function ,MESH: Graft Rejection ,Cadaver organ transplantation ,MESH: Norway ,Circadian Clocks ,Internal medicine ,medicine ,Humans ,Circadian rhythm ,Aged ,Transplantation ,MESH: Humans ,business.industry ,MESH: Time Factors ,MESH: Adult ,Original Articles ,Odds ratio ,medicine.disease ,Organ transplant ,MESH: Databases, Factual ,[SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology ,Kidney Transplantation ,MESH: Male ,MESH: Prospective Studies ,Confidence interval ,MESH: France ,business ,MESH: Female - Abstract
International audience; Background and objectives The fact that metabolism and immune function are regulated by an endogenous molecular clock that generates circadian rhythms suggests that the magnitude of ischemia reperfusion, and subsequent inflammation on kidney transplantation, could be affected by the time of the day. Design, setting, participants, & measurements We evaluated 5026 individuals who received their first kidney transplant from deceased heart-beating donors. In a cause-specific multivariable analysis, we compared delayed graft function and graft survival according to the time of kidney clamping and declamping. Participants were divided into those clamped between midnight and noon ( ante meridiem [ am ] clamping group; 65%) or clamped between noon and midnight ( post meridiem [ pm ] clamping group; 35%), and, similarly, those who underwent am declamping (25%) or pm declamping (75%). Results Delayed graft function occurred among 550 participants (27%) with am clamping and 339 (34%) with pm clamping (adjusted odds ratio, 0.81; 95% confidence interval, 0.67 to 0.98; P =0.03). No significant association was observed between clamping time and overall death-censored graft survival (hazard ratio, 0.92; 95% confidence interval, 0.77 to 1.10; P =0.37). No significant association of declamping time with delayed graft function or graft survival was observed. Conclusions Clamping between midnight and noon was associated with a lower incidence of delayed graft function, whereas declamping time was not associated with kidney graft outcomes.
- Published
- 2021
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