Background: Cold and warm ischemia times are known to impact DGF (delayed graft function) rates and long-term allograft survival following deceased donor kidney transplantation. We propose an additional ischemia time, namely extraction time: the interval beginning with aortic cross clamp and perfusion/cooling of the kidneys, and ending with removal of the kidneys and placement on ice on the back table. During this time the kidneys begin to rewarm, and thus suffer an additional ischemic insult, which may contribute to transplant kidney function.

Methods: We measured extraction time among 576 kidneys recovered by our OPO (NJ Sharing Network) and subsequently transplanted between 1/06 and 12/08. We linked to UNOS data to determine recipient characteristics and outcomes. Statistical analysis of donor, recipient, and transplant characteristics were performed, including logistic regression, using STATA/SE 12.1.

Results: Mean extraction time was 44.7 minutes. There was a total DGF rate of 27.8% and PNF (primary non-function) rate of 5%. In both unadjusted and SRTR-adjusted analyses, there was a statistically significant association between longer extraction time and higher odds of DGF (OR=1.03 per minute beyond 60 minutes, 95% CI 1.009-1.058, p=0.006). The association with PNF and longer extraction times was present, but only in unadjusted analysis (OR=1.04, 95% CI 1.008-1.078, p=0.015).

Conclusions: Prolonged extraction time is significantly associated with increased risk of DGF. This may be a factor to consider when evaluating a deceased donor kidney offer and when strategizing personnel for kidney recovery.

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