Prolonged cold ischemia time may not be reason to discard kidney donations
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Prolonged cold ischemia time may not be a good enough reason to discard a kidney donation, according to a study published in Kidney Medicine.
“Transplant programs should not consider prolonged cold ischemia time (CIT) as a predominant reason to decline an organ, a recommendation that is particularly relevant when kidneys are transported beyond the 250 nautical-mile radius,” Erik L. Lum, MD, from the Kidney and Pancreas Transplant Research Center in the division of nephrology of the department of medicine at the David Geffen School of Medicine at University of California, Los Angeles, and colleagues wrote in the study.
Using The Organ Procurement Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) database, the researchers conducted a retrospective observational study on 179,347 deceased donor kidney transplants between January 2000 and December 2018. Median follow-up was 4.6 years.
Researchers observed delayed graft function and primary non-function increased with CIT. However, CIT had less of an impact than the kidney donor profile index (KDPI).
Among donors with a CIT of 40 hours or more, 24.3% experienced death-censored graft failure during the follow-up. However, when kidney quality was categorized using KDPI, the 10-year death-censored graft survival of those with a CIT of 40 hours or more with a KDPI of less than 85% was 67.2%.
While UNOS did not explain why organs were discarded, data from the OneLegacy Organ Procurement Organization indicated that 8.7% of discarded kidneys were due to prolonged CIT alone or prolonged CIT with other risk factors.
“Kidneys with prolonged CIT which are frequently discarded, may provide years of dialysis independence for patients on the transplant waiting list,” Lum and colleagues wrote. “Transplant programs should not consider prolonged CIT as a predominant reason to decline an organ, a recommendation that is particularly relevant when kidneys are transported beyond the 250 nautical-mile radius.”
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