KIDNEY TRANSPLANTATION: RELATING TYPE OF GRAFT AND ISCHEMIA TIME TRANSPLANTE RENAL: RELACIONANDO TIPO DE ENXERTO E TEMPO DE ISQUEMIA TRASPLANTE RENAL: RELACIONANDO TIPO DE INJERTO Y TIEMPO DE ISQUEMIA

Objective: to evaluate the success of renal transplantation in relation to donor and recipient variables, graft type, age, complications, infections and duration of ischemia. Method: this is a quantitative study of the retrospective documentary cohort, evaluating 282 medical records of patients attended by the Renal Therapy Unit, aged over 18 years and the results were presented in the form of tables and figures. Results: it was shown that of the transplants performed, 100 were with live donor kidneys and 182 with deceased donor kidneys; 18 and 37 patients died, respectively, and the mean cold ischemia time was 25.9 hours for organs of deceased donors. Conclusion: the greater number of patients who developed infections and complications of grafts from a deceased donor is shown to be an influencing factor in the success of renal transplantation, showing that the longer the cold ischemia time, the greater it will be the loss of viable tissue from the graft, which causes a greater propensity for infectious events and failure of renal function, therefore, it is extremely important to implement actions and new behaviors, thus favoring bases for the success of renal transplants. Descriptors: Transplantation; Kidney; Tissue Donors; Ischemia; Renal Insufficiency, Chronic; Survival Analysis.

English/Portuguese J Nurs UFPE online., Recife, 13(5):1405-11, May., 2019  1406  Renal transplantation is considered the most effective renal replacement therapy in the treatment of chronic kidney disease 1 and its success depends on several factors, including the type of donor, living or deceased, and the time of cold ischemia. 2e objective of this study was to evaluate the success of kidney transplantation related to the deceased and living donor and the time of cold ischemia during the transplant process with deceased donor graft in the Renal Therapy Unit of the municipality of Pato Branco, in the years 2010 to 2015, through a quantitative study of the retrospective documentary cohort, in order to allow the recognition of the factors that influence the failure of transplantation and to raise the discussion about measures that can be solved, in addition to providing up-to-date information and provide bases for new behaviors aiming at the frequent success in renal transplantation.
It is known that the kidneys are responsible for organic homeostasis, elimination of blood impurities, blood pressure regulation, hormone production, participation in bone formation and maintenance, and ultimately stimulate the production of red blood cells.They become thus the essential kidneys to keep the body in balance. 1 It is added that renal function is measured and evaluated by the glomerular filtration rate (GFR) 3 and "its decrease is observed in chronic kidney disease". 1It is reported that, when reaching values below 60ml / min / 1.73m² , there is an expressive loss of 50% of the normal renal function and, when the GFR is far below, less than 15ml / min / 1.73m², the kidneys begin to establish renal functional failure, the stage five, the last one in relation to the loss progressive functional disorder observed in chronic kidney disease. 1,4 It is noted that the number of patients with chronic kidney disease has been increasing considerably in Brazil.This disease is treated as a public health problem that affects 330 people diagnosed in every million people in Latin America, not counting people who have not yet been diagnosed and do not belong to the data recorded. 7] Peritoneal dialysis, hemodialysis and renal transplantation are available as possible substitutive devices to prolong the life of the chronic renal patient, especially of patients in the terminal stage of renal disease. 10 is explained that renal transplantation is a surgical procedure aimed at transferring the organ from one individual to another in order to compensate for or replace a lost function.This new kidney will perform the functions that the diseased kidneys could no longer maintain. 8It is exposed that in Paraná, in the year 2017, there was a waiting list of 1,134 patients waiting for renal transplantation, however, the number of effective donors in the system was only 427. 11e can perform this procedure with a live or deceased donor graft, and studies show that the number of transplants performed with live donors has been increasing, however, the prevalence in Brazil is of transplantation with grafts from deceased donors. 12 Brazil, according to data from the year 2017, 5,929 kidney transplants were performed, 595 of them in Paraná, 77.8% of which were renal transplants from a deceased donor. 11ter receiving the renal transplantation, the receptors are at high risk for developing complications such as: cancer, cardiovascular diseases, diabetes and infection, complications that contribute to the high morbidity and premature mortality of patients. 12 renal transplantation, compared with other literature, kidney transplantation achieves better results when performed with a living donor graft than with a deceased donor. 8This is because the living donor organ suffers less or no time of cold ischemia, patient experiences less dialysis time and there is better compatibility between donor and recipient. 13 is explained that during the surgical removal of the organ from the renal transplant there is a time called cold ischemia in which "the removed kidney is transferred to and maintained in a preserved cold cell preservation solution".important, for the success of surgery and graft survival, that this process does not last more than 30 hours. 10,15 depends on several factors related to the success of kidney transplantation and allograft survival, among them, the donor and recipient, type of graft and time of ischemia.The time of cold ischemia is related to the late function of the deceased donor graft, decreasing its survival after renal transplantation, and is linked to the incidence of infectious events.  It mphasized that factors such as the postoperative period are also of great importance for graft and recipient survival, since, during this period, treatment with immunosuppressive drugs is necessary in order to prevent graft rejection and several other complications of an immunological, infectious or surgical nature.18:32 It is aided by the application of therapeutic procedures and immunopharmacology in the treatment of patients after renal transplantation, reducing the mortality rate and rejection of organs.A total of 282 records of patients attended by the Renal Therapy Unit, located at the Pato Branco Polyclinic Institute, in the city of Pato Branco (PR), were analyzed.The information was collected by consulting the physical and electronic medical records provided by the Renal Therapy Unit, and included in the study the medical records of patients older than 18 years and who underwent renal transplantation from January 2010 to December Medical records were excluded from patients who performed more than one kidney transplant in that period and / or incomplete medical records that did not contain the data necessary to achieve the research objectives.This research was developed in terms of ethical aspects, according to NHC Resolution 466/2012, of the Ministry of Health, and is submitted for the approval of the Research Ethics Committee.The study was approved by the ethics committee of the Teaching Union of the Southwest of Paraná -UNISEP, under the n.2,507,594, on February 22, 2018.All the protective measures were adopted regarding the anonymity of the participants, guaranteeing that the information should be used only for the purposes of scientific research.
It should be noted that the research showed that the mean age of the transplanted patients was 42.6 ± 13.9 years and 87.9% of the patients were 59 years of age or younger.It is shown from the transplants carried out 100 were with live donor kidney and 182 with deceased donor kidney.
The results are presented in table 1, according to the variables of the transplanted patients.18 patients who received live donor kidneys and 37 who received deceased donor kidneys as shown in table 2 were shown to have died, mean cold ischemia time was 25.9 hours for organs of deceased donors, of the patients who received these grafts and died in the years of 2010 and 2014; the cold ischemia time was over 20 hours, showing itself as a factor influencing the success of renal transplantation.It is understood that the largest number of patients who developed infections and complications were those who received graft from a deceased donor.According to the data analyzed, age was one of the risk factors in the development of metabolic and cardiovascular diseases after organ transplantation, but not with surgery failure, graft loss or patient survival.

METHOD
It is observed that the preference for joviality is related to the life expectancy being greater for the graft and the recipient and, above all, for the predisposition of the family donors. 10tients with grafts from living and deceased donors were transplanted in Pato Branco.In living donor graft transplantation, the HLA (human leukocyte antigen) compatibility between recipient and donor is of utmost importance, with one-year graft survival being observed in 95%; for haploidenics, in 85% and for distinct HLA, in 75%. 19 is observed, with data collected in the Renal Transplant Unit, an expressive number of deceased donor graft used in renal transplants, in the time space from 2010 to 2015.
It is noticed that with the technological advance in Medicine, this significant increase in relation to the use of renal graft from deceased donor, in relation to the use of live donor graft, is of great value.Based on these data, the Renal Transplant Unit, in Pato Branco, is above the national average compared to the 75% presented by the Brazilian Association of Organ Transplantation. 20The numbers in this study differ from the results of another study, 16 which showed a much lower number of transplants performed with a deceased donor graft, with only 29.05%.
It is revealed that the deceased donor kidney recipients, according to the data in the analyzed charts, were, for the most part, the group that presented complications, such as fistula and rupture, and infections (Figure 1).These complications may also be related to factors that are independent of the type of graft.In another study, 338 recipients, corresponding to 41.2% of deceased donor graft transplants, presented some infection, since it is repeated in studies.2,:512 These receptors also presented a greater risk to develop infections of 20% in front of the other transplanted ones with kidney of live donor.
It is emphasized that the kidneys of deceased donors have a certain advantage when used in transplants compared to other organs, and this is due to factors such as: the possibility of being withdrawn from donors without heart beats and by accepting a longer cold ischemia time, and can reach 36 hours. 20 tempo de isquemia fria faz parte do procedimento de transporte do órgão até seu efetivo implante. 13idneys for transplantation, regardless of whether the donor is alive or deceased, are sensitive to ischemia. 14During this process, the kidney undergoes some aggressions called, collectively, ischemia / reperfusion injury. 13 is concluded that the average time of cold ischemia, in transplants performed with organs of deceased donor in White Duck, was 25.9 hours, ranging from 15 to 42 hours.Prolonged cold ischemia was present in patients' charts indicating complications such as graft loss, delayed function and posttransplant infections, as well as in other studies 2 in which the various conditions related to ischemia time are factors in the development of infections, and also in another study, 14 which states that ischemia is associated with a decrease in graft survival, confirming the results of the research in question, in which the average cold ischemia time among patients (35) was 25.7h, ranging from 17h to 36h, justifying that the longer the preservation time in cold ischemia, the less the tissue will be viable. 14 is noteworthy in other studies that 21 graft function delay (GFD) is the most common complication in the post-transplant period with a deceased donor, reaching 50% in Brazil.The survival of the deceased donor graft is lower in relation to live donor grafts, but higher in relation to the kidneys treated with dialysis. 17 Table 2 shows the number of deaths with renal donor after renal transplantation in Pato Branco, from 2010 to 2015, in relation to the time of cold ischemia.:77 It is concluded that the live donor kidney presents better and longer graft survival at the recipient, after all, it suffers no or DISCUSSION CONCLUSION English/Portuguese J Nurs UFPE online., Recife, 13(5):1405-11, May., 2019 1410 minimal cold ischemia time, unlike the deceased donor organ, which spends more time in the cold preservation solution, which allows the major development of some infection or complication.It is thus verified that cold ischemia is a factor influencing the success of renal transplantation.
It is thought that, thus, reducing cold ischemia time and correct graft handling may yield even more positive results for successful kidney transplantation.The success or failure of a transplant is given by a set of results in which the nurse is a very important active member and who can actively promote actions to optimize the process, from the conversation with the family to the capture of organs, in the case of a deceased donor, to the correct and agile filling of the necessary documentation, making rooms and staff available in the surgical center for abstraction.It is added that, at the time of receiving the organ, the correct conference and receipt, as well as the same availability of surgical room and tissue reimplantation team, can reduce the time of cold ischemia and raise the success rates of transplantation.

Figure 1 .
Figure 1.Number of transplanted patients with deceased and alive donor graft in the group of infections and complications, from 2010 to 2015.Pato Branco (PR), Brazil, 2015. 19

Table 2 .
Number of deaths after renal transplantation, from 2010 to 2015, in relation to the time of cold ischemia.