*Purpose: Donor kidneys with prolonged cold ischemia time (CIT) and acute kidney injury (AKI) are often rejected on the view they do not achieve successful outcomes. Recent studies have shown favorable outcomes of kidney transplantation (KT) with prolonged CIT (>24 hours), however the impact of extremely prolonged CIT (defined as CIT> 38 hours) in combination with AKI (donor terminal creatinine >2.0) on patient and graft outcomes is not well defined.

*Methods: Single center retrospective review of deceased donor kidney transplant (DDKT) recipients stratified by CIT (>38 hours) and donor AKI (terminal serum creatinine (Scr) >2.0). All patients received rATG for inductionand maintenance immunosuppression with tacrolimus, mycophenolate and steroids. Delayed graft function (DGF) was defined as the need for dialysis for any reason in the 1st week post-KT. Kidney Donor Profile Index (KDPI) scoring system was used to characterize overall donor kidney quality.

*Results: Since 2013, we have performed 12 deceased KTs at our institution using deceased donor kidneys with CIT>38 hours and AKI (terminal creatinine >2.0) and analyzed the 1, 3, 6 and 12 month post-transplant patient and graft outcomes. Mean donor age was 43 years (22-64); mean terminal Scr level was 2.52 mg/dl. All kidneys had CIT >38 hours. 3 KT had CIT>40 hours. Mean CIT 40.5 (38-45). All kidneys were managed by cold storage. The 1, 3, 6, 12 month creatinine (mg/dl) were 2.36 (1.22-3.73), 1.94 (1.0-4.82), 1.35 (0.9-2.78), 1.90 (0.9-2.69). No grafts have been lost.

*Conclusions: This single center analysis of kidney transplants from deceased donors with extremely prolonged CIT>38 hours and AKI shows that presence of extremely prolong CIT and AKI may not adversely affect outcomes. The high rate of DGF does not impact long-term survival. Other centers should emulate strategies used by aggressive centers to maximize utilization and reduce discard rates.

« Back to 2019 American Transplant Congress