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Article Dans Une Revue Journal of Clinical Medicine Année : 2021

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

Résumé

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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hal-03367669 , version 1 (06-10-2021)

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David Montaigne, Nasser Alhawajri, Mathilde Jacquelinet, Amandine Coppin, Marie Frimat, et al.. Day-time declamping is associated with better outcomes in kidney transplantation: the circarein study. Journal of Clinical Medicine, 2021, 10 (11), pp.2322. ⟨10.3390/jcm10112322⟩. ⟨hal-03367669⟩
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