*Purpose: The OPTN recently proposed removing Donation Service Area (DSA) and regional boundaries used in the current kidney allocation system (KAS) and allocate organs within a 250 nautical mile (NM) radius centered on the donor hospital. The goal of this proposal is to increase equity in access for U.S. kidney transplant (KT) candidates.

*Methods: In our program, the majority of renal allografts are imported from distances ranging from 150-4800 miles. In order to study the impact of distance on cold ischemia time (CIT), delayed graft function ( DGF), patient and allograft outcomes, we studied 263 import KT performed from 2014 to 2020 and compared outcomes to locally procured KT (n=178). Zero miss-matched KT were excluded from the study. Donor and recipient demographics were similar in both groups. Induction and maintenance immunosuppression were also similar in both groups.

*Results: CIT was significantly higher in the imported group compared to local KT (27.6 vs. 15.9 hrs. p< 0.0001). Notably, the distance traveled by imported KT did not impact CIT (R2= 0.07, Fig 1). Distance did not impact the rate of DGF in both groups (imported 21% vs. local 22%, p=0.74). Furthermore, in the imported group, distance had no correlation with the DGF. Patient and allograft survival rates were similar in the imported vs. local KT group. In a multivariate analysis distance did not affect allograft or patient survival.

*Conclusions: We conclude that distance alone does not correlate with CIT and DGF as well as allograft and patient survival. There are many logistical factors and OPO factors that impact significantly on CIT. We postulate that the impact of distance is affected by many issues and cannot be predicted by travel mileage alone. Improvements in transportation options and logistics can improve utilization of organs and decrease the discard rate especially for high KDPI renal allografts.

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