Abstract: FR-PO1046

Impact of Cold Ischemia Time, Independent of DGF, on Allograft Outcomes

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Chiles, Mariana C., Columbia University, New York, New York, United States
  • Nestor, Jordan Gabriela, Columbia University, New York, New York, United States
  • Husain, Syed Ali, Columbia University, New York, New York, United States
  • Crew, Russell J., Columbia University, New York, New York, United States
  • Morris, Heather K., Columbia University, New York, New York, United States
  • Dube, Geoffrey K., Columbia University, New York, New York, United States
  • Patzer, Rachel E., Columbia University, New York, New York, United States
  • Pastan, Stephen O., Columbia University, New York, New York, United States
  • Mohan, Sumit, Columbia University, New York, New York, United States
Background

The rate of deceased donor kidney (DDK) discard is rising in the U.S., and prolonged cold ischemia time (CIT) is a frequently cited reason for discard. Although long CIT is associated with delayed graft function (DGF), the impact of both CIT and DGF on long-term survival is unclear.

Methods

To assess the risks associated with transplanting DDKs that have accrued long CIT, we used Scientific Registry of Transplant Recipients data to perform a paired kidney analysis and evaluated post-transplant death-censored graft failure. From 2000-2015, we identified 5,773 pairs (11,546 kidneys) that had a difference in CIT ≥5 hours, where 1 kidney developed DGF. The kidney from each pair with shorter CIT was included in the “short CIT” group and the kidney with longer CIT was included in the “long CIT” group.

Results

CIT for the long CIT kidneys was 24.8±8.9 hours versus 13.9±7.2 hours for the short CIT group (p<0.001). Long CIT kidneys were more likely to develop DGF (26.0% vs 22.4%, p<0.001). When examining pairs in which at least 1 kidney developed DGF and using the kidneys with short CIT and no DGF as the reference, kidneys that developed DGF had a higher probability of graft failure over the study period regardless of CIT (long CIT with DGF OR=1.87, p<0.001; short CIT with DGF OR=1.81, p<0.001; Figure 1), but kidneys with long CIT had no difference in graft failure (OR 0.98, p=0.71). In multivariable analysis, only recipients who developed DGF (whether with short or long CIT) had a higher risk of allograft failure compared to recipients of short CIT kidneys that did not experience DGF (long CIT with DGF OR=2.07, p<0.001; short CIT with DGF OR=1.98, p<0.001).

Conclusion

Kidneys with longer CIT had a marginally increased incidence of DGF, but long CIT was not associated with increased graft failure after stratifying recipients by DGF development. DGF describes a clinically heterogeneous entity resulting from multiple factors beyond prolonged CIT.

Figure 1

Funding

  • Other U.S. Government Support