ATC Abstracts

American Transplant Congress abstracts

  • Home
  • Meetings Archive
    • 2022 American Transplant Congress
    • 2021 American Transplant Congress
    • 2020 American Transplant Congress
    • 2019 American Transplant Congress
    • 2018 American Transplant Congress
    • 2017 American Transplant Congress
    • 2016 American Transplant Congress
    • 2015 American Transplant Congress
    • 2013 American Transplant Congress
  • Keyword Index
  • Resources
    • 2021 Resources
    • 2016 Resources
      • 2016 Welcome Letter
      • ATC 2016 Program Planning Committees
      • ASTS Council 2015-2016
      • AST Board of Directors 2015-2016
    • 2015 Resources
      • 2015 Welcome Letter
      • ATC 2015 Program Planning Committees
      • ASTS Council 2014-2015
      • AST Board of Directors 2014-2015
      • 2015 Conference Schedule
  • Search

Implications of Accumulated Cold Time for US Kidney Transplantation Offer Acceptance

M. Barah1, V. Kilambi2, J. Friedewald1, S. Mehrotra1

1Industrial Engineering and Management Sciences, Northwestern University, Evanston, IL, 2Department of Engineering and Applied Sciences, RAND Corporation, Arlington, VA

Meeting: 2022 American Transplant Congress

Abstract number: 7

Keywords: Allocation, Kidney transplantation, Renal ischemia, Resource utilization

Topic: Clinical Science » Kidney » 31 - Kidney Deceased Donor Allocation

Session Information

Session Name: Kidney Deceased Donor Allocation

Session Type: Rapid Fire Oral Abstract

Date: Sunday, June 5, 2022

Session Time: 3:30pm-5:00pm

 Presentation Time: 3:50pm-4:00pm

Location: Hynes Ballroom C

*Purpose: Reducing discard is a current focus in US transplantation of deceased donor kidneys. One cause for the discards is the avoidance of protracted cold ischemia times (CIT). Extended CIT at transplant is associated with additional risk of graft failure and patient mortality. A preference for local or low-KDRI (kidney donor risk index) organs, the endogeneity of CIT during organ allocation, and the use of provisional offers all complicate the analysis of CIT’s influence on kidney acceptance decision making.

*Methods: Using 01/2018-06/2019 UNOS data we modelled the probability of accepting an offer for a kidney after provisional acceptance. We use logistic regression (LR) that includes CIT, KDRI, and other covariates selected from literature. Endogeneity of CIT is treated by a two-stage approach.

*Results: LR results for 1.73 million provisional acceptances from 12647 donors and 108313 candidates quantify tradeoffs between CIT at the time of offer acceptance and donor-recipient characteristics. Overall, each additional hour of CIT impacts acceptance for nonlocal and local recipients (OR=0.87, OR=0.95; p < 0.001). For KDRI >1.75 (KDPI>85) kidneys, an additional hour of CIT for nonlocal and local recipients impacts acceptance with OR=0.80 (nonlocal) and OR=0.84 (local); p<0.001. The impact of an additional hour of CIT on acceptance of kidneys with KDRI <=1.75 (KDPI <= 85) is less pronounced for nonlocal offers (OR= 0.91; p < 0.001) and not significant for local offers.

*Conclusions: The current kidney allocation system broadly distributes high-KDRI organs. As CIT is accumulated in the provisional-actual acceptance process, emphasizing local placement and reducing CIT may promote uptake and reduce discard risk of high KDRI donor kidneys.

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

To cite this abstract in AMA style:

Barah M, Kilambi V, Friedewald J, Mehrotra S. Implications of Accumulated Cold Time for US Kidney Transplantation Offer Acceptance [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/implications-of-accumulated-cold-time-for-us-kidney-transplantation-offer-acceptance/. Accessed May 28, 2025.

« Back to 2022 American Transplant Congress

Visit Our Partner Sites

American Transplant Congress (ATC)

Visit the official site for the American Transplant Congress »

American Journal of Transplantation

The official publication for the American Society of Transplantation (AST) and the American Society of Transplant Surgeons (ASTS) »

American Society of Transplantation (AST)

An organization of more than 3000 professionals dedicated to advancing the field of transplantation. »

American Society of Transplant Surgeons (ASTS)

The society represents approximately 1,800 professionals dedicated to excellence in transplantation surgery. »

Copyright © 2013-2025 by American Society of Transplantation and the American Society of Transplant Surgeons. All rights reserved.

Privacy Policy | Terms of Use | Cookie Preferences