Cold ischemic time is critical in outcomes of expanded criteria donor renal transplantation

Abstract

The outcomes of expanded criteria donor (ECD) kidneys have been reported to be inferior compared with standard criteria donor (SCD) kidneys. However, the graft survival rate of ECD is not so inferior to SCD in Korea. The purposes of this study were to compare the outcomes of ECD kidneys with SCD kidneys and identify the influencing factors. We retrospectively studied 143 deceased donor transplants from August 2006 to June 2010. The patients were divided into SCD (n = 117) and ECD (n = 26) by UNOS criteria. The one- and three-yr graft survival rates of SCD and ECD (99.1% and 94.4% vs. 100% and 92.9%, respectively, p = 0.15) were not significantly different between groups. The mean cold ischemic time (CIT) was 3.8 ± 2.2 h. When compared the outcome of ECD kidneys with data reported by Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients (OPTN/SRTR) (one- and three-yr graft survival rate: 86.7% and 73.2%), the graft survival rate of our center was superior. In OPTN/SRTR data, transplant with CIT shorter than 11 h was only 20%. The outcomes of ECD grafts are outstanding and comparable with SCD grafts in our center, and the only distinguishing factor is markedly short CIT. Finishing the allocation before organ recovery and immediate operations after recovery could shorten the CIT.

Analysis of local versus imported expanded criteria donor kidneys: A single‐center experience with 497 ECD kidney transplants

“…For example, in a recent study of 3839 brain‐dead donor kidney transplant recipients between 2000 and 2011, every hour of increase in CIT was associated with a 2% increased risk of graft loss and all‐cause mortality independent of immunological factors and DGF . In a study by Kim et al . minimizing cold ischemia eliminated any differences in survival outcomes between ECD and SCD kidney transplant recipients.…”

“…Growing acceptance and use of ECD kidneys with prolonged CIT has been tempered by concerns that these kidneys exhibit an increased susceptibility to ischemia‐reperfusion injury (and a reduced repair capacity) leading to enhanced immunogenicity . ECD kidneys evoke caution for many transplant centers, and when combined with longer CIT, attain an almost prohibitive status for some as both prolonged CIT categorization and ECD categorization have been identified as strong independent risk factors for DGF, reduced graft survival, and kidney discard . The presence of DGF is an early surrogate marker of organ quality and preservation that represents a combined response to a series of ischemic, reperfusion, inflammatory, and immunological injuries .…”

“…The association between prolonged CIT and adverse graft and patient outcomes is well established in deceased donor kidney transplantation . For example, in a recent study of 3839 brain‐dead donor kidney transplant recipients between 2000 and 2011, every hour of increase in CIT was associated with a 2% increased risk of graft loss and all‐cause mortality independent of immunological factors and DGF .…”

“…With the limitations inherent in transplanting ECD kidneys, a significant proportion of ECD underutilization has been attributed to risk aversion due to perceived regulatory penalties related to suboptimal outcomes . Moreover, because the new KAS fosters regional and national sharing of ECD kidneys, an unintended consequence may be longer cold ischemia times (CIT), which may have an additional negative effect on outcomes and utilization . To better understand the benefits and risks of importing ECD kidneys, we performed a single‐center retrospective study to compare outcomes of local vs imported ECD kidneys in patients receiving standardized management algorithms.…”

Advances in the Knowledge about Kidney Decellularization and Repopulation

“…Furthermore, there are an increasing number of elderly donors and recipients for KT (Wolfe et al, 2010; Abecassis et al, 2012). US initiatives, for example, have resulted in an increase in non-conventional sources of donors, such as expanded criteria donors (ECD) (Port et al, 2002; Stratta et al, 2006; Pascual et al, 2008; Klein et al, 2010), donors after cardiac death donation (DCD) (Howard et al, 2005; Abt et al, 2006; Farney et al, 2011), standard criteria donors (SCD) with warm ischemia times or prolonged cold (CIT) (Roodnat et al, 2003; Kayler et al, 2011; Kim et al, 2013; Debout et al, 2015; Xia et al, 2015), acute kidney injury (AKI) donors (Anil Kumar et al, 2006; Kayler et al, 2009; Farney et al, 2013; Hall et al, 2015; Heilman et al, 2015; Xia et al, 2015), double-kidney transplantation (DKT) and donors at the extremes of age (Johnson et al, 1996; Cruzado et al, 2007; De Serres et al, 2010; Fernández-Lorente et al, 2012). Recently, it was demonstrated that desensitization of the patient and subsequent transplantation with a kidney from an incompatible live donor increase the patient survival rate compared with those who remain on the waiting list for transplantation (Orandi et al, 2016).…”