The following is a summary of the “Cold Ischemia Time, Kidney Donor Profile Index, and Kidney Transplant Outcomes: A Cohort Study,” published in the January 2023 issue of Kidney medicine by Lum, et al.
In the United States, approximately 3,280 kidneys are lost each year after being recovered from deceased donors. More time spent in cold ischemia is linked to a higher rate of organ decline and eventual removal from the patient. This study aimed to evaluate how extended periods of cold ischemia affect kidney transplant success.
Time spent in cold ischemia positively correlated with delayed graft function incidence (20.9%, 28.1%, 32.4%, 37.5%, and 35.8%). The same trend was seen for the primary nonfunction group with increasing cold ischemia time (0.6%, 0.9%, 1.3%, 2.1%, and 2.1%, respectively), and 37,301 recipients experienced death-censored graft failure over a median follow-up period of 4.6 years. Death-censored graft survival at 10 years was significantly different depending on the kidney donor’s profile index (KDPI), with 71.0% (95% CI, 70.5%-71.5%), 70.5% (95% CI, 69.9%-71.0%), 69.6% (95% CI, 68.7%-70.4%), 65.5% (95% CI, 63.7%-67.3%), and 67.2% (95% CI, 64.6%-69).
Acceptance of kidneys that have been exposed to cold ischemia for too long varies widely between transplant centers, and there are likely to be confounding factors involved. Graft dysfunction and primary nonfunction were more likely to be delayed in patients whose grafts had been exposed to cold for longer. Increased cold ischemia time does have some effect, but it is much smaller than the KDPI. In particular, if the KDPI is less than 85%, transplant centers shouldn’t reject an organ because of how long it was exposed to cold ischemia.
Source: sciencedirect.com/science/article/pii/S2590059522002035