Elevated deceased donor (DD) serum creatinine (SCr) levels and prolonged cold ischemia time (CIT) are major independent reasons for kidney discard following organ recovery. Many kidneys are declined locally because of acute kidney injury (AKI), which results in longer CIT as these kidneys are offered regionally and then nationally. The study purpose was to analyze the combined effect of these 2 factors on kidney transplant (KT) outcomes. Methods: We performed a single center retrospective analysis in adult DD KT patients (pts) receiving AKI donor kidneys. AKI was defined as doubling in the admit SCr and terminal SCr >2.0 mg/dl. Outcomes were stratified according to longer CIT categories. Delayed graft function (DGF) was defined as the need for dialysis in the 1st week post-KT. Results: Since 1/1/07, we performed 118 KTs from 89 AKI DDs. Mean DD age was 35 years; mean DD admit and terminal SCr levels were 1.2 mg/dl and 3.1 mg/dl, respectively. 27 KTs (23%) had CITs <20 hrs, 52 (44%) 20-<30 hrs, 30 (25%) 30-<40 hrs, and 9 (8%) ≥40 hrs. The proportion of imported kidneys (66% overall) increased with longer CIT category (30%, 67%, 90% and 89%, respectively, p<0.0001). Most kidneys (87%) were managed with both cold storage and machine perfusion (mean pump time 12.2 hrs, mean total CIT 26.3 hrs). The overall incidence of DGF was 41.5%; the DGF rate with longer CIT category was 30%, 48%, 33%, and 67%, respectively (p=NS). With mean follow-up of 52 months, overall pt and kidney graft survival rates were 91% and 81%, respectively. Death-censored graft survival (DCGS) rates were 84% and 88% for pts with and without DGF (p=NS). DCGS rates were 92% in pts with CIT <20 hrs compared to 85% in those with CIT ≥20 hrs (p=NS). In the 9 pts with CITs ≥40 hrs, the 4-year DCGS rate was 100%. Conclusions: These findings suggest that the presence of both AKI and prolonged CIT may not adversely influence intermediate-term outcomes, particularly when imported kidneys are placed on short-term machine preservation prior to KT. The presence of DGF likewise does not affect outcomes. Discard of AKI donor kidneys because of projected long CIT is not warranted.

CITATION INFORMATION: Khan M, Carrier A, El-Hennawy H, Farney A, Rogers J, Orlando G, Reeves-Daniel A, Palanisamy A, Gautreaux M, Iskandar S, Doares W, Kaczmorski S, Stratta R. Is Prolonged Cold Ischemia a Contraindication to Using Kidneys from Acute Kidney Injury Donors? Am J Transplant. 2016;16 (suppl 3).

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