title: Elimination of warm ischemia using the Ice Bag Technique does not decrease delayed graft function.
abstract: BACKGROUND
  Warm ischemic time (WIT) in kidney transplantation has significant effects on graft survival, function, and postoperative morbidity. We utilized the Ice Bag Technique (IBT) to determine if eliminating WIT would decrease the incidence and length of delayed graft function (DGF) in our cohort.
  
  
  METHODS
  We conducted a prospective study of 150 kidney transplants. We compared the elimination of WIT with IBT to traditional methods. Data was analyzed using non-parametric statistical tests.
  
  
  RESULTS
  66 of the 134 patients underwent transplantation using IBT. 28 right kidneys, 34 left kidneys, and 4 dual kidneys were implanted successfully. Patients with a body mass index (BMI) as high as 41 were transplanted. Kidneys with up to three arteries and two veins, and kidneys up to 15.5 by 9 cm in size were safely transplanted into either iliac fossa. Despite the complete elimination of WIT, there was no difference in DGF, length of DGF, length of stay graft rejection, graft survival, patient survival, or wound or urologic complications between groups (p > 0.05).
  
  
  CONCLUSIONS
  The elimination of warm ischemic time using the IBT does not appear to reduce the incidence or length of DGF in this cohort. The technique may be useful for cases with prolonged anastomosis time (AT), but further studies with larger cohorts are required to determine whether it decreases DGF.
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA. Electronic address: karipinf@einstein.edu.
authors.forename: Farah
authors.initials: F
authors.lastname: Karipineni
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Stalin
authors.initials: S
authors.lastname: Campos
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Afshin
authors.initials: A
authors.lastname: Parsikia
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Joel B
authors.initials: JB
authors.lastname: Durinka
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Po-Nan
authors.initials: PN
authors.lastname: Chang
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Kamran
authors.initials: K
authors.lastname: Khanmoradi
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Radi
authors.initials: R
authors.lastname: Zaki
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Ortiz
mesh_terms: D000328:Adult; D003080:Cold Temperature; D051799:Delayed Graft Function / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007053:Ice; D007430:Intraoperative Care / Q000379:methods; D007668:Kidney / Q000098:blood supply; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D052096:Warm Ischemia / Q000009:adverse effects*
chemical_list: D007053:Ice
keywords: Delayed; Function; Graft; Ischemia; Warm