COLD ISCHAEMIA TIME IMPORTANT FACTOR IN OUTCOME OF KIDNEY TRANSPLANT

Prolonged cold ischaemia time versus better HLA matching their impact on the outcome of renal transplant has been the subject of a study by John Roberts, MD and colleagues of the University of California, San Francisco.

They analysed data from 63,688 recipients of cadaveric renal transplants reported to UNOS Scientific registry between 1990 and 1998. The findings were reported in the archives of surgery, September, 2000. It was found that five- year graft survival was significantly associated with cold ischaemic time. The rates were 68.3%, 63.1% and 59.9%, respectively for grafts kept cold for less than 24 hours, 24 to 36 and longer than 36 hours. HLA matching also affected the 5 –year survival rate, which was 71.3% in recipients with zero mismatches.

However recipients of kidneys with zero mismatches but with cold ischaemia time greater than 36 hours had no survival advantage over patients with mismatched kidneys kept cold for less than 24 hours. Delayed graft function appeared to be affected more by cold ischaemia time than by the number of HLA mismatches.

Nutritional guidelines for CRF patients

A long felt need in the case of children and adults with chronic renal failure has been addressed by the national kidney foundation, USA. It has released the K/DOQ / clinical practice guide lines for nutrition in Chronic Renal Failure. The guidelines include two important issues;

1. Recommendations for evaluating protein- energy nutritional status.
2. Prescribing appropriate levels of dietary energy and protein intake.