The Edge of Glory: Determinants of Success and Failure for Prolonged Cold Ischemia in Kidney Transplantation
1Surgery, Banner University of Arizona Medical Center, Tucson, AZ, 2Medicine, Banner University of Arizona Medical Center, Tucson, AZ
Meeting: 2021 American Transplant Congress
Abstract number: 866
Keywords: Cadaveric organs, Machine preservation, Outcome, Preservation
Topic: Clinical Science » Kidney » Kidney Deceased Donor Selection
Session Information
Session Name: Kidney Deceased Donor Selection
Session Type: Poster Abstract
Session Date & Time: None. Available on demand.
Location: Virtual
*Purpose: Prolonged cold ischemia time (CIT>30 hours) is associated with an increased risk of primary non-function and early graft loss in kidney transplantation, although this risk is incompletely characterized. We sought to evaluate outcomes of kidney transplants at our center with CIT>30 hours from 2010-2019.
*Methods: 166 kidney transplants with CIT>30 hours were performed at our center from 2010-2019. We compared transplants with graft loss (n=20) and EGFR<40 ml/min (n=39) at 1 year (total n=59) to transplants with eGFR>40 ml/min at 1 year (n=107) with multivariable logistic regression using backward stepwise variable selection (p<0.1). Variables included recipient age, gender, race, BMI, DM, re-transplantation, EPTS, cPRA; donor age, terminal creatinine, CIT, anastomosis time, pump status, terminal pump flow and resistive index, KDPI, recovery/post perfusion biopsy Remuzzi score, and DCD status.
*Results: There were no significant demographic differences between recipients of either group. The average cold ischemia time was similar between groups, 40±6 hours (p=0.59). Transplants with graft loss or eGFR<40 ml/min at one year were more likely to be DCD donors (47.5% vs. 25.2%, p=0.004; OR=3.95, 95% CI=1.64-9.50), or higher KDPI (66±19% vs. 59.6±21%, p=0.04; OR=1.31, 95% CI=1.03-1.69). Kidneys with graft loss or eGFR<40 ml/min at one year were less likely to have been placed on machine pulsatile perfusion (76% vs. 90%, p=0.05; OR=0.19, 95% CI=0.06-0.61).
*Conclusions: Successful utilization of kidneys with prolonged cold ischemia time is possible with careful donor selection. Graft loss and eGFR<40 ml/min at one year is associated with kidneys transplanted from DCD donors and those with high KDPI. Machine perfusion may mitigate the risk of prolonged CIT.
| N=166 | eGFR>40 ml/min at 1 year | eGFR<40 ml/min at 1 year and/or failed allograft | P-value |
| N | 107 | 59 | |
| Recipient age | 61.8 ±11.0 | 63.4 ±10.5 | 0.36 |
| DM % | 56.1 | 59.3 | 0.69 |
| BMI | 28.5 ±5.0 | 28.8 ±5.1 | 0.71 |
| EPTS, % | 57.7 ±31.8 | 56.2 ±32.8 | 0.78 |
| N=166 | eGFR>40 ml/min at 1 year | eGFR<40 ml/min at 1 year and/or failed allograft | P-value |
| KDPI, % | 59.6 ±21.0 | 66.4 ±19.1 | 0.04 |
| DCD, % | 25.2 | 47.5 | 0.004 |
| Pump, % (n=123) | 90.0 | 76.7 | 0.05 |
| Terminal Scr, (n=128) | 2.00 ±1.96 | 1.71 ±1.77 | 0.41 |
| Remuzzi biopsy score (0-12), (n=118) | 3.1 ±2.3 | 3.3 ±2.1 | 0.64 |
| eGFR at 1 year, ml/min (n=146), if graft not failed | 52.5 ±15.2 | 31.5 ±7.6 | <0.001 |
To cite this abstract in AMA style:
Turner A, Hamidi M, Ariyamuthu V, Harland R, Tanriover B. The Edge of Glory: Determinants of Success and Failure for Prolonged Cold Ischemia in Kidney Transplantation [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/the-edge-of-glory-determinants-of-success-and-failure-for-prolonged-cold-ischemia-in-kidney-transplantation/. Accessed May 9, 2025.« Back to 2021 American Transplant Congress