Impact Of Cold And Warm Ischemia Time On Outcomes For Kidneys Donated After Cardiac Death
1New York Presbyterian, New York, NY, 2Columbia University Medical Center, New York, NY
Meeting: 2019 American Transplant Congress
Abstract number: 221
Keywords: Kidney transplantation, Outcome
Session Information
Session Name: Concurrent Session: Kidney Donor Selection / Management Issues II
Session Type: Concurrent Session
Date: Monday, June 3, 2019
Session Time: 2:30pm-4:00pm
Presentation Time: 2:54pm-3:06pm
Location: Ballroom C
*Purpose: Donors after cardiac death (DCD) organs are frequently being discarded. Prolonged warm (WIT) cold (CIT) ischemia times are often important considerations in the discard of DCD kidneys, but their impact on post-transplant outcomes is unclear. We examined the association of ischemia time on delayed graft function (DGF) and death-censored graft failure for DCD kidneys.
*Methods: The 2017 Scientific Registry of Transplant Recipients, Standard Analysis File (SRTR, SAF) was utilized to identify post-KAS DCD kidney transplants occurring from 2015-2017. We included all recipients of DCD kidneys who had both WIT and CIT recorded. Cox regression and logistic regression were used to calculate the hazard of death-censored graft failure and odds of delayed graft function, respectively.
*Results: We identified 2,705 kidneys from DCD donors transplanted from 2015-2017. Median WIT was 21.0 min (IQR 14.0-28.0), 44% of kidneys had WIT 20-40 min, and 11% had WIT >40 min. Median CIT was 18.5 hours (IQR 13.9-23.5), 14% had CIT 24-30 hours, and 11% had CIT >30 hours. The overall incidence of DGF was 42.7%. In a multivariable logistic regression model examining odds of DGF, donor age (aOR 1.02 per year, 95% CI 1.01-1.02), extended CIT (24-30 hours: aOR 1.39, 95% CI 1.11-1.74; >30 hours: aOR 1.41, 95% CI 1.10-1.80) and WIT (20-40 min: aOR 1.19, 95% CI 1.01-1.40; >40 min: aOR 1.01, 95% CI 0.78-1.32) were associated with increased odds of DGF [Table 1]. However, in a multivariable cox regression model estimating the hazard of death-censored graft failure, only the highest category of CIT yielded a significant positive association (aHR 1.93, 95% CI 1.10-3.38).
*Conclusions: Prolonged WIT and CIT were associated with increased DGF but not death-censored graft failure in recipients of DCD kidney transplants in the post-KAS era. Extended ischemia alone, with the exception of extreme CIT, should not be used as a basis for discard of these organs. Longer follow up of this cohort is needed.
To cite this abstract in AMA style:
Brennan C, Sandoval PR, Husain SA, Tsapepas D, Mohan S, Ratner LE. Impact Of Cold And Warm Ischemia Time On Outcomes For Kidneys Donated After Cardiac Death [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-of-cold-and-warm-ischemia-time-on-outcomes-for-kidneys-donated-after-cardiac-death/. Accessed May 9, 2025.« Back to 2019 American Transplant Congress