Influence of prolonged cold ischemia in renal transplantation

Clin Transplant. 2011 Nov-Dec;25(6):E612-6. doi: 10.1111/j.1399-0012.2011.01510.x. Epub 2011 Sep 15.


Aim: To determine to what extent current cold ischemia times (CITs) affect the results of renal transplantation in the Netherlands.

Methods: Retrospective survey of the Dutch Organ Transplant Registry concerning transplants from deceased donors between 1990 and 2007.

Results: A total of 6322 recipients were identified, of whom 5306 received a kidney from deceased heartbeating (HBD) and 1016 from donors after cardiac death (DCD). Mean CIT was 24.0 ± 7.9 h in HBD and 21.6 ± 6.7 h in DCD. The percentage delayed graft function (DGF) was 12.3 and 50.4, respectively (p < 0.001). Primary non-function (PNF) occurred in, respectively, 1.7% and 5.0% (p < 0.001). Serum creatinine after three months was 166 μM in HBD and 213 μM in DCD (p < 0.001). Five-yr graft survival was 79.5% and 78.3%, respectively (p = ns). In multivariate analysis, CIT proved to be an independent risk factor for DGF and PNF. Shorter CIT was associated with better graft survival in both groups with a hazard ratio of 1.024 (1.011-1.037, 95% CI)/h. CIT <20 h was associated with a graft survival benefit of 3% after five yr in HBD and CIT of <16 h with a benefit of 10% in DCD.

Conclusions: Longer CITs are associated with the occurrence of DGF, PNF and decreased graft survival in the Netherlands.

MeSH terms

  • Adult
  • Cadaver
  • Cold Ischemia / adverse effects*
  • Delayed Graft Function*
  • Female
  • Graft Rejection*
  • Humans
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Organ Preservation*
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Tissue and Organ Harvesting*
  • Treatment Outcome