Cold ischemia time up to 16 hours has little impact on living donor kidney transplant outcomes in the era of kidney paired donation

Abstract

In living donor transplantation, cold ischemia time is a concern in transplants involving kidney paired donation. The impact of cold ischemia time over eight hours is unknown. Here we examined the association of cold ischemia time with delayed graft function and allograft loss among 48,498 living recipients in the Scientific Registry of Transplant Recipients registry. The incidence of delayed graft function was low but significantly higher among patients with longer cold ischemia times (0-2.0 hours: 3.3%; 2.1-4.0 hours: 3.9%; 4.1-8.0 hours: 4.3%; 8.1-16.0 hours: 5.5%). In multivariate analyses, only those with cold ischemia times of 8.1-16.0 hours had increased odds of delayed graft function (odds ratio 1.47; 95% confidence interval 1.05-2.05) compared to patients with times of 0-2.0 hours. In multivariate time-to-event analyses, cold ischemia times of 16 hours or less were not associated with allograft loss from any cause including death or death-censored graft loss with hazard ratios for cold ischemia times between 8.0-16.0 hours of 0.97 (95% confidence interval 0.74-1.26) and 1.09 (0.81-1.48) compared to patients with times of 0-2.0 hours). The results were consistent in paired and non-kidney paired donation transplants and in those with living donors over 50 years of age. In subgroup analysis restricted to kidney paired donation recipients, there was no difference in the risk of delayed graft function with an odds ratio of 1.40 (0.88, 2.40) or all-cause graft loss with a hazard ratio of 0.89 (0.62, 1.30) in transplant recipients who received kidneys that were shipped versus not shipped. Thus, a cold ischemia time up to 16 hours has limited impact on living donor outcomes. These findings may help expand living donor transplantation through kidney paired donation.

Outcomes and surgical complications following living‐donor renal transplantation using kidneys retrieved with trans‐peritoneal or retro‐peritoneal hand‐assisted laparoscopic nephrectomy

“…Overall PNF (0.3%) and DGF (2.2%) rates observed in the present study are similar to the best results described in the literature 35 and reflect the short extraction time achieved with HALDN. Consistently maintaining cold ischemia time (CIT) below three hours has also undoubtedly played a role 35-37 but we do believe that other non‐measurable factors might have been beneficial. Specifically, during both TP‐HALDN and RP‐HALDN we have always allowed adequate time for the kidney to “rest” before stapling, ensuring optimal mean arterial pressure being established.…”

“…Consistently maintaining cold ischemia time (CIT) below three hours has also undoubtedly played a role [35][36][37] This practice is shared by many transplant centers and reduces the inevitable stress on the mentored surgeon while maintaining the highest quality of the service without the effects of multiple learning curves. 30,38 Reported incidence of DGF after LDRT varies from 4% to 10%, depending on the series.…”

Die ersten 50 roboterassistierten Donornephrektomien

“…Ganz unabhängig davon sind die Operationszeiten bei Horgan et al [13] [17]. Auch wenn eine längere KIZ kein signifikanter Prädiktor für eine postoperativ schlechtere Nierenfunktion ist, zeigt sich tendenziell ein schlechteres Outcome, wenn die KIZ 2 h übersteigt [9,22]. Während der "Wartezeit" auf das Absetzen der Niere wird das Pneumoperitoneum bei uns vollständig abgelassen, damit sich die Spenderniere erholen kann.…”

“…Die französischen Kollegen aus Nancy erreichen nach 150 RDN eine mediane Operationszeit von 176 ± 23 min, aber nehmen eine fast dreimal so lange KIZ von 206 ± 71 min in Kauf, weil sie die Patienten nacheinander operieren [ 17 ]. Auch wenn eine längere KIZ kein signifikanter Prädiktor für eine postoperativ schlechtere Nierenfunktion ist, zeigt sich tendenziell ein schlechteres Outcome, wenn die KIZ 2 h übersteigt [ 9 , 22 ]. Während der „Wartezeit“ auf das Absetzen der Niere wird das Pneumoperitoneum bei uns vollständig abgelassen, damit sich die Spenderniere erholen kann.…”

Kidney-paired donation to increase living donor kidney transplantation in India: Guidelines of Indian Society of Organ Transplantation – 2017

“…Gill et al . [ 52 ] reported that cold ischemia time ≤16 h has little impact on LDKT outcomes. The one option is for the kidney donor to travel to the center where recipient is admitted.…”