*Purpose: Currently, there is an ongoing debate regarding the efficient use of available organs (utility) versus the fair access to transplant (equity). UNOS is now proposing allocation of KT based on distance from the donor hospitals. A distance within 250 or 500 miles will receive additional points to access KT. This concept was adapted in an effort to reduce cold ischemia times (CIT), decrease delayed graft function (DGF) rates and provide better outcomes and graft survival.

*Methods: In our program, 70% of our kidney transplants were imported from long distances ranging from 150-4800 miles. In order to study the impact of distance on CIT, DGF and patient and graft outcomes, we studied 221 import KT performed from 2014 to 2019 and compared outcomes to locally procured KT (n=160). Zero miss-matched KT were excluded from the study.

*Results: Donor and recipient demographics were similar in both groups. Induction and maintenance immunosuppression were similar in both groups. Although, CIT was significantly higher in the imported group (27.6 vs. 15.9 hrs, p< 0.0001), amongst the imported KT’s, distance did not impact CIT (R²= 0.07) Fig 1. Distance also did not impact the rate of DGF in both groups (imported 21% vs. 22%, p=0.74). Furthermore, in the imported group, distance had no correlation with the DGF (R²= 0.001), Fig 2. Patient and graft survivals were similar in the imported vs. local group. In multivariate analysis distance did not affect graft or patient survivals.

*Conclusions: We conclude that distance alone has no correlation with CIT and DGF after 150 miles. There are many logistical factors and OPO factors that impact significantly on CIT. Frequently organs procured from greater distances arrive with considerably less CIT than closer donor hospitals. We believe the impact of distance on CIT and DGF is affected by many factors and cannot be predicted only by mileage from the transplant center.

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