Clinicians may be reluctant to transplant small pediatric kidneys that also have prolonged cold ischemia time (CIT) for fear of an additional deleterious effect since pediatric grafts are thought to be more sensitive to ischemia. We performed a retrospective cohort study examining US registry data between 1998-2013 of adult first-time kidney-only recipients of small pediatric kidneys from donors weighing 10-20 kg, stratified by CIT levels of 0-18 (n=1413), 19-30 (n=1116) and > 30 (n=338) hours. All cause graft survival by CIT groups at 1-year was 92%, 88%, and 89% and at 5-years 76%, 70% and 66%, respectively. Risk-adjusted graft survival was comparable between recipients with CIT 19-30 (aHR 1.12, 95%CI 0.96-1.31) and CIT >30 (aHR 1.14, 95%CI 0.91-1.43) relative to recipients with CIT 0-18 hours. There was also little variation in graft survival when restricted to single kidney transplants only. Relative to the shortest CIT group, risk-adjusted graft survival at 1 year was comparable at CIT 19-30 (aHR 1.00, 95%CI 0.76-1.33) and CIT > 30 (aHR 1.06, 95%CI 0.71-1.60). 1-year acute rejection by CIT category was 8%, 9%, and 6% and was comparable after risk adjustment. These results suggest that in the setting of a prior ischemic donor event, prolonged CIT has limited bearing on long-term outcomes of small pediatric donor kidney transplants.

CITATION INFORMATION: Kayler L, Lubetzky M, Friedman P. Influence of Cold Ischemia Time in Kidney Transplants from Small Pediatric Donors. Am J Transplant. 2016;16 (suppl 3).

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