Prolonged cold ischemia did not prevent successful transplantation
Shipping live-donor kidneys to transplant centers over long distances—even transcontinentally—does not adversely affect recipient outcomes, a recent experience involving four transplant centers suggests.
Investigators presented details of a chain of eight donor-exchange transplants facilitated by three transcontinental shipments and one intrastate shipment of live-donor kidneys. The four shipped kidneys were all packed in ice and then transported, unaccompanied, by commercial airlines to the recipients' hospitals with local Organ Procurement Organization involvement. These kidneys were transported and transplanted without incident, said Fauzia K. Butt, MD, a transplant surgery fellow and Clinical Instructor at the University of California at Los Angeles (UCLA). At three to six months post-transplant, all allografts were functioning well, said Dr. Butt, who was involved in the first transplant.
The chain was initiated by an altruistic donor in New York City who underwent a laparoscopic donor nephrectomy at New York Presbyterian-Weill Cornell Medical Center. That kidney was then packed on ice, taken by courier to the airport, and flown by commercial jet to Los Angeles for transplantation at UCLA. The kidney had 14 hours of cold ischemia prior to transplantation. “However, it produced urine immediately in the OR upon reperfusion,” Dr. Butt stated. She added: “The kidney showed absolutely no signs of jet lag. It acted as if it had taken a journey from the OR next door, not a trip across the country.” At six months post-transplantation, the recipient's serum creatinine level was 1.2 mg/dL and she was doing well.
Additional kidneys were transported from Los Angeles to Palo Alto, Calif., for transplantation at Stanford University, from Palo Alto to New York City for transplantation at New York Presbyterian-Weill Cornell Medical Center, and from New York to San Francisco for transplantation at California Pacific Medical Center. The cold ischemia times for these kidneys were 8, 12, and 11 hours, respectively. The recipients' serum creatinine levels at three months were 1.5, 1.3, and 1.7, respectively.
“This experience demonstrates that it is not necessary to transport the donor, as is customary, but that transportation of living-donor kidneys is a viable option, similar to what is routinely done for deceased-donor kidneys on a daily basis,” Dr. Butt told Renal & Urology News. “If individuals can be spared traveling long distances to the recipients' transplant centers in unfamiliar surroundings, [donors] could recover from their surgery amongst friends and family, and additional people might be inspired to become live donors. The results would be an expansion of the donor pool with quality living-donor kidneys.”
The experience of Dr. Butt and colleagues echoes that of other transplant teams. In 2007, Robert A. Montgomery, MD, PhD, Director of the Johns Hopkins Comprehensive Transplant Center in Baltimore, and colleagues performed the first transplant of a live-donor kidney transported over a long distance. The kidney came from San Francisco on a chartered flight. Although the kidney had a cold ischemia time of eight hours, the recipient had prompt renal function and had a serum creatinine level of 1.1 mg/dL one year post-transplant, Dr. Montgomery's group reported in the American Journal of Transplantation (2008;8:2163-2168). That kidney was part of a three-way kidney paired donation.
A previous study by him and other investigators provided the basis for transplanting a live-donor kidney flown across the continent. The researchers analyzed United Network for Organ Sharing (UNOS) data from 38,467 live-donor kidney recipients and found no difference in graft outcomes between patients who received organs after up to eight hours of cold ischemia and those who received their organs immediately, according to findings published in the American Journal of Transplantation (2007;7:99-107).
Commenting on Dr. Butt's presentation, Dr. Montgomery said “it's very important that other centers have similar experiences in order to validate our single-center data and the conclusions we have drawn from the UNOS live donor database.”
The need for live donors to travel to recipients' hospital is one of the main barriers to a regional or national kidney paired donation program, he said. Among other hardships, the trips incur financial costs and involve separation from family and friends, he noted. “Shipping the organs seems like the most reasonable way to solve that problem,” Dr. Montgomery said.
Not requiring donors to travel could greatly increase the number of donor-recipient matches because physical distance between donors and recipients would no longer be a major factor, he said.