title: Cold ischemia time in renal transplantation is reduced by a timesheet in a French transplant center.
abstract: BACKGROUND
  Cold ischemia time (CIT) is associated with delayed graft function (DGF) and transplant outcome. Several strategies to reduce CIT have been proposed. We retrospectively analyzed the effect of using a timesheet on CIT in our center.
  
  
  METHODS
  In the last 2 years, we have introduced a timesheet to study the course of organ procurement and transplantation during CIT. Results of our 2-year program (121 transplantations) were compared to those in the preceding 2 years (151 transplantations). The timing of each intervention and the influence of national sharing policy and priority recipients were recorded.
  
  
  RESULTS
  CIT decreased significantly from 21.45 to 13.27 hours (P<0.0001) and the DGF rate from 34.7 to 20.7% (P=0.011). Usually, human leukocyte antigen typing was done before kidney removal and the recipient was evaluated in the evening or at night for a transplant procedure starting in the morning. Only 1 of 121 transplantations started during the night. The availability of an operating room was the limiting factor. Sharing organs for national priority with a crossmatch having been performed increased CIT twofold (P<0.0001).
  
  
  CONCLUSIONS
  Using a timesheet significantly reduced CIT to the shortest in France. The timesheet is an indicator of motivation and requires the collaboration of all transplantation personnel. It identified certain habits that may be improved to minimize CIT without reorganizing the unit. Providing quicker access to the operating room should further reduce CIT, the key to better graft survival.
authors.affiliation: Centre de Néphrologie et Transplantation Rénale, Hôpital Conception, Marseille, France. hvacher@mail.ap-hm.fr
authors.forename: Henri
authors.initials: H
authors.lastname: Vacher-Coponat
authors.forename: Raj
authors.initials: R
authors.lastname: Purgus
authors.forename: Monica
authors.initials: M
authors.lastname: Indreies
authors.forename: Valérie
authors.initials: V
authors.lastname: Moal
authors.forename: Hervé
authors.initials: H
authors.lastname: Luciani
authors.forename: Eric
authors.initials: E
authors.lastname: Lechevallier
authors.forename: Véronique
authors.initials: V
authors.lastname: Delaporte
authors.forename: Aline
authors.initials: A
authors.lastname: Luccioni
authors.forename: Hélène
authors.initials: H
authors.lastname: Julian
authors.forename: Denis
authors.initials: D
authors.lastname: Reviron
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dussol
authors.forename: Yvon
authors.initials: Y
authors.lastname: Berland
mesh_terms: D001012:Aorta, Abdominal; D005602:France; D006650:Histocompatibility Testing; D006801:Humans; D007511:Ischemia; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology / Q000592:standards* / Q000706:statistics & numerical data; D010477:Perfusion; D013997:Time Factors; D017748:Time Management / Q000458:organization & administration*; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods; D016896:Treatment Outcome