*Purpose: Warm ischemic time (WIT) during donation after cardiac death (DCD) kidney transplantation has significant effects on post-operative outcomes, such as graft survival, function, and post-operative mortality and morbidity. As second WIT also occurs while the kidney rewarms during the anastomosis (WIT2). We applied cooling using an ice blanket technique (IBT) to see if eliminating WIT2 would decrease the incidence of delayed graft function (DGF) and improve functional outcomes.

*Methods: Adult DCD kidney transplants performed at our center between 2017 and 2018 were reviewed (N=32). Transplants were performed as standard (non-IBT, n=15) and in ice blanket group (IBT: the graft was covered with crushed ice within a doubly folded small laparotomy pad during implantation of the graft, n=17). We compared early and late outcomes of graft function between these cohorts including DGF and graft function. Data was analyzed using non-parametric statistical tests.

*Results: Demographic characteristics were not different between the groups of recipients. Donor and recipient demographics were similar between groups. Standard criteria donors (SCD) and expanded criteria donors (ECD) comprised about 70% and 30% in both groups. There was no difference in procurement WIT or cold ischemic times (CIT ) between the two groups (p = 0.58 and p = 0.19, respectively).Both groups were followed up for 3 months period. On days 1, 3, and week 4, IBT grafts had superior renal function vs. non-IBT (p < 0.05). Although there was no difference in DGF between groups, the median number of dialysis sessions was 2 (2-3) in the IBT and 4 (2-6) in the non-IBTS groups. Slow graft function rates were higher in the non-IBTS group, accordingly.

*Conclusions: Decrease in overall WIT using IBT improved renal function and slow graft function. Although this is a preliminary study with ongoing data collection, it provides proof of principle that IBT should be considered as an inexpensive and easy modality to improve patient outcomes. Further studies with IBT will be necessary in order to truly determine whether the elimination of WIT2 provides improved outcomes in the long-term.

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