Does prolonged cold ischemia affect outcomes in donation after cardiac death donor kidney transplants?

Abstract

Background The purpose of this study was to analyze the combined effect of cold ischemia time (CIT) and donation after cardiac death (DCD, with requisite warm ischemia time, WIT) on kidney transplant (KT) outcomes. Methods Single center retrospective review of DCD KT recipients stratified by CIT. Results From 6/08 to 10/20, we performed 446 DCD KTs (115 CIT ≤20, 205 CIT 20–30, 88 CIT 30–40, 38 CIT ≥40 h). Mean WITs (26/25/27/23 min) and KDPI values (59%/55%/55%/59%) were similar while mean CITs (16.4/23.6/33.4/42.5 h) and pump times (10.3/13.6/16.1/20.4 h) differed across groups (P < .05). With a mean 6‐year follow‐up, patient survival (84%/84%/74%/84%) was similar. Kidney graft survival (GS) (72%/72%/56%/58%) and death censored GS (DCGS) (82%/80%/63%/67%) rates decreased whereas rates of primary nonfunction (PNF, .9%/2.4%/9.1%/7.9%) and delayed graft function (DGF) (36%/48%/50%/69%) increased with longer CIT (≥30 h, P < .05). Meaningful years free of dialysis, which we refer to as Allograft Life Years, were achieved in all cohorts (4.5/4.3/3.9/4.3 years per patient transplanted). Conclusion DCD donor kidneys with prolonged CIT (≥30 h) are associated with increased rates of DGF and PNF, along with decreased GS and DCGS. Despite this, Allograft Life Years were gained even with longer CITs, demonstrating the utility of using these allografts.

Mitochondria Transplantation Mitigates Damage in an In Vitro Model of Renal Tubular Injury and in an Ex Vivo Model of DCD Renal Transplantation

“…Finally, as 40% of the renal transplants performed in the Unite States are DCD renal transplants, alternative, more effective approaches that may improve the function and the overall outcome of "less than optimal graft" are urgently needed. Our transplant program has a broad, longstanding experience in the use of such allografts including DCD kidneys [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] and our patients would see potential benefit from treatments that mitigate DCD kidney damage. Overall, our ex vivo data confirmed the beneficial effects of MITO observed in vitro.…”

Prolonged cold ischemia and kidney donation after cardiac death

“…To the Editor, We read with great interest the article by Harriman et al who reported the important association of prolonged cold ischemia and outcomes of kidneys donated after cardiac death. 1 We congratulate the authors on this novel and important finding, and would like to highlight several points. First, the authors definition of warm ischemia time (WIT) corresponds to "donor" WIT, prior to organ retrieval.…”

Cold Storage Followed by Transplantation Induces Interferon-Gamma and STAT-1 in Kidney Grafts

“…Cold storage (CS) solutions such as Viaspan are typically used to maintain the viability of deceased donor kidneys [ 5 , 6 , 7 , 8 , 9 ] until a recipient can be chosen. However, a well-known contributing factor to poor graft outcomes is prolonged exposure to CS, and we previously demonstrated in a rat model that CS exacerbates renal injury after transplantation [ 10 , 11 , 12 , 13 ]. After brain death, there is a robust inflammatory response that can damage deceased donor kidneys, which may also contribute to deceased donor graft vulnerability throughout CS [ 14 , 15 ].…”