Maximum cold ischemia duration for a kidney allograft: a prediction model for allograft failure at the time of organ allocationResearch in context
Summary: Background: Many determinants of kidney allograft failure are established at the time of allocation by organ distribution agencies. At this point, the main modifiable factor is the duration of cold ischemia (CIT). Currently, no practical tool exists to determine the maximum permissible col...
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Elsevier
2025-07-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537025002548 |
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| author | Clement Gosset Susana Barbosa Alexandre Destere Sebastien Cuozzo Laetitia Albano Emmanuel Morelon Xavier Charmetant Moglie Le Quintrec Jean-Emmanuel Serre Marc Ladrière Sophie Girerd Christophe Masset Dany Anglicheau Carmen Lefaucheur Gillian Divard Enrico Gruden Matthieu Durand Dirk Kuypers Maarten Coemans Nicolas Glaichenaus Oriol Bestard Anders Åsberg Magali Giral Maarten Naesens Antoine Sicard |
| author_facet | Clement Gosset Susana Barbosa Alexandre Destere Sebastien Cuozzo Laetitia Albano Emmanuel Morelon Xavier Charmetant Moglie Le Quintrec Jean-Emmanuel Serre Marc Ladrière Sophie Girerd Christophe Masset Dany Anglicheau Carmen Lefaucheur Gillian Divard Enrico Gruden Matthieu Durand Dirk Kuypers Maarten Coemans Nicolas Glaichenaus Oriol Bestard Anders Åsberg Magali Giral Maarten Naesens Antoine Sicard |
| author_sort | Clement Gosset |
| collection | DOAJ |
| description | Summary: Background: Many determinants of kidney allograft failure are established at the time of allocation by organ distribution agencies. At this point, the main modifiable factor is the duration of cold ischemia (CIT). Currently, no practical tool exists to determine the maximum permissible cold ischemia time for a specific recipient at allocation. Methods: We analyzed two prospective cohorts of kidney transplant recipients from European centers: a derivation cohort of 7040 patients from 10 centers (Barcelona; Leuven; Oslo; Paris Necker, Lyon, Nantes, Nancy, Montpellier, Nice, Paris Saint Louis) with data collected between 2005 and 2020, and a validation cohort of 6131 patients from 6 French centers (Paris Necker, Lyon, Nantes, Nancy, Montpellier, Nice) with data collected between 2008 and 2019. The main outcome was allograft failure (return to dialysis or pre-emptive retransplantation). We assessed 26 determinants of allograft failure available at the time of allograft allocation including cold ischemia time as a modifiable factor. Prediction models were developed using a classical survival analysis and a competing risk framework. Findings: Allograft failure occurred in 16% (1113) of the derivation cohort and 14% (832) of the validation cohort. Independent determinants of allograft failure were donor age (HR 2.2 [1.9–2.6] for donors above 65 years old), previous allografts (HR 1.5 [1.3–1.6]), dialysis history (HR 1.7 [1.3–2] for Hemodialysis), diabetes (HR 1.4 [1.2–1.6]), vascular disease (HR 1.3 [1.1–1.5]), HLA-DR incompatibility (HR 1.2 [1.1–1.3]), donor serum creatinine (HR 1 [1–1]), and cold ischemia time (HR 1 [1–1]). Donor age was the strongest contributor, while cold ischemia was the only modifiable factor. These factors were combined into two predictive models of kidney allograft failure (Cox regression and Fine Gray) showing accurate calibration, and discrimination with a C-Index of 0.66 (95% CI: 0.63–0.70 at year one) on the validation cohort for the Fine Gray model. The Fine–Gray model, which accounts for the competing risks between allograft failure and patient death, was used to develop a practical tool for predicting allograft failure based on cold ischemia. Interpretation: Prediction model at the time of allocation provides a simple and practical tool which may guide organ distribution agencies and medico-surgical teams by customizing cold ischemia time for a kidney allograft transplantation. Funding: Centaure Foundation (SIREN 499,947,398–http://www.fondation-centaure.org) none of the funding sources had any role in study. |
| format | Article |
| id | doaj-art-4e863a218dc44031be7f8b4d928a33c3 |
| institution | Kabale University |
| issn | 2589-5370 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj-art-4e863a218dc44031be7f8b4d928a33c32025-08-20T03:30:13ZengElsevierEClinicalMedicine2589-53702025-07-018510332210.1016/j.eclinm.2025.103322Maximum cold ischemia duration for a kidney allograft: a prediction model for allograft failure at the time of organ allocationResearch in contextClement Gosset0Susana Barbosa1Alexandre Destere2Sebastien Cuozzo3Laetitia Albano4Emmanuel Morelon5Xavier Charmetant6Moglie Le Quintrec7Jean-Emmanuel Serre8Marc Ladrière9Sophie Girerd10Christophe Masset11Dany Anglicheau12Carmen Lefaucheur13Gillian Divard14Enrico Gruden15Matthieu Durand16Dirk Kuypers17Maarten Coemans18Nicolas Glaichenaus19Oriol Bestard20Anders Åsberg21Magali Giral22Maarten Naesens23Antoine Sicard24Laboratory of Molecular Physio Medicine (LP2M), UMR 7370, CNRS, University Côte d’Azur, Nice, France; Department of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nice, Nice, France; Corresponding author. Laboratory of Molecular Physio Medicine (LP2M), UMR 7370, CNRS, University Côte d’Azur, Nice, France.Institute of Molecular and Cellular Pharmacology (IPMC), UMR 7275 CNRS, University Côte d’Azur, Nice, FranceDepartment of Pharmacology, University Hospital Centre of Nice, Nice, FranceDepartment of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nice, Nice, FranceDepartment of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nice, Nice, FranceDepartment of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University Claude Bernard Lyon 1, Villeurbanne, FranceDepartment of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University Claude Bernard Lyon 1, Villeurbanne, FranceDepartment of Nephrology-Dialysis-Transplantation, University Hospital Centre of Montpellier, Montpellier, FranceDepartment of Nephrology-Dialysis-Transplantation, University Hospital Centre of Montpellier, Montpellier, FranceDepartment of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nancy, Nancy, FranceDepartment of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nancy, Nancy, FranceCHU Nantes, Nantes Université, Service de Néphrologique, Institut de Transplantation Uro-Néphrologique, Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, F-44000, FranceDepartment of Transplantation, University Hospital Centre of Necker, Paris, FranceDepartment of Nephrology-Dialysis-Transplantation, University Hospital Centre of Saint Louis, Paris, FranceDepartment of Nephrology-Dialysis-Transplantation, University Hospital Centre of Saint Louis, Paris, FranceDepartment of Organ Procurement Coordination, University Hospital Centre of Nice, Nice, FranceDepartment of Urology, University Hospital Centre of Nice, Nice, FranceDepartment of Microbiology, Immunology and Transplantation, KU Leuven, Belgium; Department of Nephrology, University Hospitals Leuven, Leuven, BelgiumDepartment of Microbiology, Immunology and Transplantation, KU Leuven, Belgium; Department of Nephrology, University Hospitals Leuven, Leuven, BelgiumInstitute of Molecular and Cellular Pharmacology (IPMC), UMR 7275 CNRS, University Côte d’Azur, Nice, FranceDepartment of Nephrology and Kidney Transplantation Nephrology department, Bellvitge University Hospital, Vall d’Hebron University Hospital, Barcelona, SpainDepartment of Transplantation Medicine, Oslo University Hospital, Norway; Department of Pharmacy, University of Oslo, Oslo, NorwayCHU Nantes, Nantes Université, Service de Néphrologique, Institut de Transplantation Uro-Néphrologique, Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, F-44000, FranceDepartment of Microbiology, Immunology and Transplantation, KU Leuven, Belgium; Department of Nephrology, University Hospitals Leuven, Leuven, BelgiumLaboratory of Molecular Physio Medicine (LP2M), UMR 7370, CNRS, University Côte d’Azur, Nice, France; Department of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nice, Nice, FranceSummary: Background: Many determinants of kidney allograft failure are established at the time of allocation by organ distribution agencies. At this point, the main modifiable factor is the duration of cold ischemia (CIT). Currently, no practical tool exists to determine the maximum permissible cold ischemia time for a specific recipient at allocation. Methods: We analyzed two prospective cohorts of kidney transplant recipients from European centers: a derivation cohort of 7040 patients from 10 centers (Barcelona; Leuven; Oslo; Paris Necker, Lyon, Nantes, Nancy, Montpellier, Nice, Paris Saint Louis) with data collected between 2005 and 2020, and a validation cohort of 6131 patients from 6 French centers (Paris Necker, Lyon, Nantes, Nancy, Montpellier, Nice) with data collected between 2008 and 2019. The main outcome was allograft failure (return to dialysis or pre-emptive retransplantation). We assessed 26 determinants of allograft failure available at the time of allograft allocation including cold ischemia time as a modifiable factor. Prediction models were developed using a classical survival analysis and a competing risk framework. Findings: Allograft failure occurred in 16% (1113) of the derivation cohort and 14% (832) of the validation cohort. Independent determinants of allograft failure were donor age (HR 2.2 [1.9–2.6] for donors above 65 years old), previous allografts (HR 1.5 [1.3–1.6]), dialysis history (HR 1.7 [1.3–2] for Hemodialysis), diabetes (HR 1.4 [1.2–1.6]), vascular disease (HR 1.3 [1.1–1.5]), HLA-DR incompatibility (HR 1.2 [1.1–1.3]), donor serum creatinine (HR 1 [1–1]), and cold ischemia time (HR 1 [1–1]). Donor age was the strongest contributor, while cold ischemia was the only modifiable factor. These factors were combined into two predictive models of kidney allograft failure (Cox regression and Fine Gray) showing accurate calibration, and discrimination with a C-Index of 0.66 (95% CI: 0.63–0.70 at year one) on the validation cohort for the Fine Gray model. The Fine–Gray model, which accounts for the competing risks between allograft failure and patient death, was used to develop a practical tool for predicting allograft failure based on cold ischemia. Interpretation: Prediction model at the time of allocation provides a simple and practical tool which may guide organ distribution agencies and medico-surgical teams by customizing cold ischemia time for a kidney allograft transplantation. Funding: Centaure Foundation (SIREN 499,947,398–http://www.fondation-centaure.org) none of the funding sources had any role in study.http://www.sciencedirect.com/science/article/pii/S2589537025002548Predictive modelAllograft allocationCold ischemiaKidney transplantation |
| spellingShingle | Clement Gosset Susana Barbosa Alexandre Destere Sebastien Cuozzo Laetitia Albano Emmanuel Morelon Xavier Charmetant Moglie Le Quintrec Jean-Emmanuel Serre Marc Ladrière Sophie Girerd Christophe Masset Dany Anglicheau Carmen Lefaucheur Gillian Divard Enrico Gruden Matthieu Durand Dirk Kuypers Maarten Coemans Nicolas Glaichenaus Oriol Bestard Anders Åsberg Magali Giral Maarten Naesens Antoine Sicard Maximum cold ischemia duration for a kidney allograft: a prediction model for allograft failure at the time of organ allocationResearch in context EClinicalMedicine Predictive model Allograft allocation Cold ischemia Kidney transplantation |
| title | Maximum cold ischemia duration for a kidney allograft: a prediction model for allograft failure at the time of organ allocationResearch in context |
| title_full | Maximum cold ischemia duration for a kidney allograft: a prediction model for allograft failure at the time of organ allocationResearch in context |
| title_fullStr | Maximum cold ischemia duration for a kidney allograft: a prediction model for allograft failure at the time of organ allocationResearch in context |
| title_full_unstemmed | Maximum cold ischemia duration for a kidney allograft: a prediction model for allograft failure at the time of organ allocationResearch in context |
| title_short | Maximum cold ischemia duration for a kidney allograft: a prediction model for allograft failure at the time of organ allocationResearch in context |
| title_sort | maximum cold ischemia duration for a kidney allograft a prediction model for allograft failure at the time of organ allocationresearch in context |
| topic | Predictive model Allograft allocation Cold ischemia Kidney transplantation |
| url | http://www.sciencedirect.com/science/article/pii/S2589537025002548 |
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