# Impact of Vascular Anastomosis Time on Kidney Transplant Outcomes – A Systematic Review

## TL;DR

This systematic review finds that longer vascular anastomosis time during kidney transplants is linked to worse outcomes like delayed graft function and reduced graft survival.

## Contribution

The study systematically reviews the impact of anastomosis time on kidney transplant outcomes, highlighting its potential role as a modifiable intraoperative factor.

## Key findings

- Longer anastomosis time is consistently associated with higher rates of delayed graft function.
- Prolonged anastomosis time correlates with poorer 1- and 5-year graft survival.
- Patient survival findings are inconsistent and require further investigation.

## Abstract

Anastomotic time (AT), also termed second warm ischaemic time (SWIT), is a potentially important intraoperative factor in kidney transplantation, yet its impact on outcomes has not been systematically synthesised. We conducted a systematic review to examine the association between AT and delayed graft function (DGF), graft survival, and patient survival. Cochrane, Embase, and Medline were searched to 21 July 2025. Nine retrospective cohort studies comprising 155,523 transplants were included. Across all donor types, longer AT was consistently associated with higher rates of DGF within individual studies. Several studies also reported poorer 1- and 5-year graft survival with prolonged AT, while findings for patient survival were equivocal. However, substantial heterogeneity across studies, including donor type, AT definitions, outcome reporting, and incomplete adjustment for key confounders, precluded formal meta-analysis. None of the included studies consistently adjusted for major determinants of graft outcomes. These findings suggest a potential link between prolonged AT and adverse graft outcomes, but high-quality prospective studies with standardised reporting and confounder adjustment are required before AT can be considered an independent determinant of transplant outcomes.

https://www.crd.york.ac.uk/prospero/, identifier PROSPERO CRD42024549222.

Infographic summarizing a systematic review on how vascular anastomosis time affects kidney transplant outcomes. Prolonged anastomotic time leads to ischemia reperfusion injury, delayed graft function, and reduced graft survival. Study conclusions note delayed graft function is proportional to anastomotic time, and prolonged time results in inferior one- and five-year graft survival. The review includes nine retrospective studies with over one hundred fifty-five thousand kidneys. Main conclusion emphasizes shorter anastomotic time improves graft outcomes after kidney transplantation.