title: Impact of cold ischemia time on graft survival among ECD transplant recipients: a paired kidney analysis.
abstract: Delays in expanded criteria donor (ECD) kidney placement increases cold ischemia times (CIT) potentially leading to discard. The effect of increased CIT on ECD kidney transplant outcomes is unknown. We evaluated paired ECD kidneys (derived from the same donor transplanted to different recipients) from the SRTR registry transplanted between 1995 and 2009 (n = 17,514). To test the effect of CIT, we excluded paired transplants with the same CIT (n = 3286). Of 14,230 recipients (7115 donors) the median difference in CIT was 5 h (Q1 = 3 h, Q3 = 9 h). Delayed graft function (DGF) was significantly more likely between pairs with greater CIT (35% vs. 31%, p < 0.001) including substantially higher rates for CIT differences ≥ 15 h (42%). Overall graft loss was not significantly different between recipients with higher CIT relative to paired donor recipients with lower CIT (p = 0.47) or for pairs with differences of 1-3 h (p = 0.90), 4-9 h (p = 0.41), 10-14 h (p = 0.36) or ≥ 15 h (p = 0.10). Results were consistent in multivariable models adjusted for recipient factors. Although increasing cold ischemia time is a risk factor for DGF among ECD kidney transplants, there is no effect on graft survival which may suggest an important utility for donor kidneys that may not currently be considered viable.
authors: Shands Hospital at the University of Florida Gainesville, FL, USA. liisekayler@yahoo.com
authors: L K
authors: LK
authors: Kayler
authors: J
authors: J
authors: Magliocca
authors: I
authors: I
authors: Zendejas
authors: T R
authors: TR
authors: Srinivas
authors: J D
authors: JD
authors: Schold
mesh_terms: D050377:Cold Ischemia; D051799:Delayed Graft Function / Q000401:mortality*; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006680:HLA Antigens / Q000378:metabolism; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting
chemical_list: D006680:HLA Antigens