Outcomes of kidney paired donation transplants in relation to shipping and cold ischaemia time

Abstract

SUMMARYTo assess the impact of shipping distance and cold ischaemia time (CIT) of shipped organs in a kidney paired donation (KPD) programme, we evaluated the outcomes of the initial 100 kidney transplants performed in the Australian KPD programme. In a 44-month period, 12 centres were involved in fifteen 2-way, twenty 3-way, one 4-way and one 6-way exchanges. Sixteen kidneys were transplanted at the same hospital (CIT 2.6 AE 0.6 h) and 84 required transport to the recipient hospital (CIT 6.8 AE 2.8 h). A spontaneous fall in serum creatinine by at least 10% within 24 h was observed in 85% of recipients, with no difference between nonshipped and shipped kidneys. There were two cases of transient delayed graft function requiring dialysis and patient and graft survival at 1 year were 99% and 97%, respectively. There was no difference in recipients of nonshipped compared with shipped kidneys with regard to serum creatinine at 1 month (mean difference (MD) 7.3 lmol/l, 95% CI À20.2 to 34.8, P = 0.59), 1-year graft survival (MD 3.9%, 95% CI À5.4 to 13.2, P = 0.41) or patient survival (MD À2.4%, 95% CI À10.0 to 5.2, P = 0.54). Despite prolonged CIT for interstate exchanges, the programme's decision to ship donor kidneys rather than the donor appears to be safe.

Time of cold ischemia and delayed graft function in a cohort of renal transplant patients in a reference center

“…In our study, a prolonged CIT behaved as an independent risk factor for DGF, in which for each hour of CIT, the risk of DGF was increased by 10% (OR 1.10, 95% CI 1.04–1.16); however, a prolonged CIT was not a risk factor for renal graft dysfunction or AR 1 year after renal transplantation – a finding similar to that reported by previous studies. [ 3 5 15 ] Opelz et al . reported that the increase in CIT up to 18 hours did not increase the risk of renal graft loss.…”

“…[ 1 2 ] Delayed graft function (DGF) is among the known risk factors for renal graft loss,[ 1 2 ] a complication that occurs in up to 50% of patients of deceased donors. [ 3 4 5 6 ] Different risk factors have been associated with the risk of DGF, among them are the creatinine values of the donor and the cold ischemia time (CIT),[ 1 3 ] the latter defined as the period elapsed after the cessation of circulation, when perfusion begins with preservation solutions, until the beginning of the vascular anastomosis in the renal graft recipient. [ 7 8 ]…”

Six end-stage renal disease patients benefited from first non-simultaneous single center 6-way kidney exchange transplantation in India

“…Therefore, transport of living donor kidney may be a feasible alternative to donor travel in multicenter simultaneous KPD program where CIT < 8 h[8,9]. Australian program preferred to ship donor kidneys rather than the donor despite prolonged CIT for interstate exchanges[10]. In India, there is only one report of multicenter simultaneous KPD of 5 DRP[11].…”

Past, present and future of kidney paired donation transplantation in India

“…The long term graft survival is not significantly affected when cold ischemia time is short (< 8 h). Despite prolonged cold ischemia time for interstate exchanges, the Australian kidney exchange program preferred to transport donor kidneys rather than kidney donors[60]. However, there is no multi-centre kidney paired donation transplant practice in India.…”