Cold ischemia and the reduced long-term survival of cadaveric renal allografts

Abstract

(1) Cadaveric kidneys continue to undergo prolonged periods of cold ischemia; (2) prolonged cold storage is associated with longer distance traveled by the kidneys, but is not associated with any significant gain in tissue matching; and (3) prolonged cold ischemia is a significant predictor of long-term graft loss. Reducing prolonged cold ischemia by regional distribution of organs and less stringent tissue matching may reduce the persistent high rate of long-term loss of cadaveric renal allografts.

Role of Poly-(ADP-Ribose) Polymerase in Transplant Acute Tubular Necrosis and Its Relationship With Delayed Renal Function

“…10,16 This present study revealed a severe intensity of immunohistochemical expression of PARP-1 in the tubular cells of human transplant kidneys with ATN and demonstrated a relationship between the highest tubular expression of PARP-1 and delayed renal function. In addition, transplanted kidneys in patients with serum creatinine levels that did not fall to Ͻ1.7 mg/dL presented almost double the intensity of PARP-1 expression.…”

“…8,9 Salahudeen et al recently studied 6465 kidney transplant patients using UNOS data and concluded that prolonged cold ischemia is a significant predictor of long-term graft loss. 10 The prognosis is complicated by the fact that reperfusion, although essential for the survival of ischemic renal tissue, causes additional damage (reperfusion injury) 11,12 that contributes to the renal dysfunction and injury associated with I/R of the kidney. 8,12 Within the kidney, the proximal tubule appears to be particularly susceptible to I/R injury, leading to ATN, which plays a pivotal role in the pathogenesis of early transplanted kidney dysfunction.…”

Cold ischemic injury of transplanted kidneys: new insights from experimental studies

“…The limitation of UW solution is also evident in clinical practice. Data analysis from the UNOS shows high failure rates for kidneys subjected to cold storage over 24 h (47,61). With the accrual of new information on the cellular and molecular mechanisms of cold ischemic injury, it is also clear that the protection strategy employed for UW solution is too simplistic.…”

“…However, for logistical reasons cold storage and hence cold ischemic injury are likely to continue. A recent analysis of recent UNOS clinical data reported that 1) cadaveric kidneys on average still continue to undergo long periods of cold ischemia, 2) kidneys with longer cold ischemia time have the worse posttransplant kidney function, and 3) cold ischemia continues to negatively impact renal allograft survival (61).…”

“…The higher graft failure due to cold ischemia adds to kidney scarcity by requiring the recipients to return to the waiting list. According to the United Network of Organ Sharing (UNOS) registry, the average cold storage time has remained at ϳ21 h over the last decade (61). Thus prolonged cold ischemia remains a persistent problem with costly and serious consequences that merit scientific consideration.…”