title: Influence of Cold Ischemia Time in Combination with Donor Acute Kidney Injury on Kidney Transplantation Outcomes.
abstract: BACKGROUND
  Deceased-donor kidneys are often exposed to ischemic events from donor instability, as evidenced by acute kidney injury (AKI). Clinicians may be reluctant to transplant kidneys with AKI that also have prolonged cold ischemia time (CIT) for fear of an additional deleterious effect.
  
  
  METHODS
  We evaluated national data between 1998 and 2013 of adult first-time kidney-only recipients of paired kidneys from donors with AKI (terminal serum creatinine ≥ 2 mg/dL), in which the CIT difference between recipients was ≥1, 5, 10, or 15 hours.
  
  
  RESULTS
  On multivariate analysis of AKI kidney recipients, overall death-censored graft survival (DCGS) was comparable between recipients with higher CIT relative to paired donor recipients with lower CIT when the CIT difference was at least 1 hour (adjusted hazard ratio [aHR] 0.98, 95% CI 0.85 to 1.13, n = 4,458), 5 hours (aHR 0.97, 95% CI 0.79 to 1.18, n = 2,412), 10 hours (aHR 0.82, 95% CI 0.59 to 1.15, n = 922), or 15 hours (aHR 0.94, 95% CI 0.57 to 1.58, n = 442). Overall patient survival of the longer CIT groups was comparable or protective with delta CIT of ≥1 (aHR 0.94, 95% CI 0.83 to 1.06), 5 (aHR 0.80, 95% CI 0.68 to 0.94), 10 (aHR 0.70, 95% CI 0.53 to 0.91), and 15 (aHR 0.64, 95%CI 0.43 to 0.95) hours. Between each of the 4 delta-CIT levels of shorter and longer CIT, there were no statistically significant differences in the proportion of acute rejection at delta ≥1, 5, 10, or 15 hours.
  
  
  CONCLUSIONS
  These results suggest that in the setting of a previous ischemic donor event, prolonged CIT has limited bearing on long-term outcomes. This may be important evidence that despite the occurrence of other ischemic events, kidneys with prolonged CIT offer acceptable outcomes to recipients and are a potential source to expand the donor pool.
authors.affiliation: Department of Surgery, Montefiore Medical Center, Bronx, NY; Department of Surgery, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Yu
authors.initials: Y
authors.lastname: Xia
authors.affiliation: Department of Surgery, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Patricia
authors.initials: P
authors.lastname: Friedmann
authors.affiliation: Department of Surgery, Montefiore Medical Center, Bronx, NY; Department of Surgery, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Cortes
authors.affiliation: Department of Medicine, Montefiore Medical Center, Bronx, NY.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Lubetzky
authors.affiliation: Department of Surgery, Montefiore Medical Center, Bronx, NY; Department of Surgery, Albert Einstein College of Medicine, Bronx, NY. Electronic address: liisekayler@yahoo.com.
authors.forename: Liise K
authors.initials: LK
authors.lastname: Kayler
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications*; D000328:Adult; D000368:Aged; D050377:Cold Ischemia / Q000009:adverse effects*; D051799:Delayed Graft Function / Q000209:etiology*; D005260:Female; D006084:Graft Rejection / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D012042:Registries; D012307:Risk Factors; D016019:Survival Analysis; D014019:Tissue Donors