*Purpose: Recent organ allocation changes have increased travel and subsequent cold ischemia times (CIT) of kidney allografts. We sought to investigate the impact of prolonged CIT on kidney transplant outcomes at a center with a regional airport.

*Methods: A retrospective study was done evaluating kidney transplant patients treated at an academic medical center from January 1st, 2018 to May 1st, 2020. We identified 117 patients within this group that received a deceased donor kidney with over 30 hours of CIT. Patients were divided into two categories (CIT 30-35.99 hours; 36+ hours). Kidney function was evaluated using creatinine at 12 months as an endpoint. Recipient and donor characteristics (age, gender, KDPI, BMI, medication, CMV/BK status) were also evaluated for association with CIT and subsequent outcomes.

*Results: Among the 117 patients analyzed in this study, there was no significant difference in creatinine at 12 months between groups with CIT above 36 hours and <35.99 hours (2.07, 1.78. p-value .2339). Of note, when comparing the mean of patients’ 12-month creatinine values with solely their medication regimens, there was a significant difference between those that were on calcineurin inhibitors and those that were not on a calcineurin inhibitor-based regimen (1.69, 2.96. p-value .0267).

*Conclusions: Our study indicates that prolonged CITs over 36 hours are not associated with poorer patient outcomes at 1 year. The data also supports the usage of calcineurin-based regimens in this graft population. Transplantation of grafts with cold ischemia times longer than 36 hours should be considered in regional centers with limited direct national flights.

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