Recipients of carefully selected deceased-donor kidneys with a cold ischemia time (CIT) of 36 hours or longer do not have worse transplant outcomes compared with those who receive kidneys with a shorter CIT, according to study findings presented at the 2022 American Transplant Congress (ATC 2022) in Boston, Massachusetts.

Consequently, investigators concluded, transplantation of kidneys with a CIT of 36 hours or more should be considered by regional centers in places with limited direct national flights, a factor that can increase organ transport time.

“The changes in kidney allocation have increased the logistical complexity of getting the grafts into patients,” lead investigator Lyle J. Burdine, MD, PhD, a transplant surgeon at the University of Arkansas for Medical Sciences in Little Rock, said in an interview with Renal & Urology News. The result has been an increase in the number of donor kidneys with prolonged CIT arriving at his transplant center.

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The finding that a CIT of 36 hours or more does not adversely affect transplant outcomes could expand the pool of acceptable kidneys to offer patients and potentially shortens the waiting time for a transplant. A kidney transplant would free patients from dialysis, improve their lives, and enable them to return to work, an important consideration given the very limited financial and health care resources of the patient population that his center serves, Dr Burdine noted.

Dr Burdine and colleagues conducted a retrospective study of 117 kidney transplant recipients who received deceased-donor kidneys from 2018 to 2020. The investigators divided patients according to the CIT of the kidneys they received: 30-35.99 and 36+ hours. Each group had 54 patients.

Mean creatinine levels at 12 months — the study’s primary endpoint — did not differ significantly between the groups (2.07 and 1.78 mg/dL in the CIT 30-35.99 and 36+ groups, respectively), the investigators reported in a poster presentation. Both groups had similar rates of rejection, consistent with previously published rates for kidney transplantation, they noted.

Results also revealed that patients who received immunosuppression with calcineurin inhibitors had significantly lower creatinine levels at 12 months compared with those who did not (1.69 vs 2.96 mg/dL).

On multivariable analysis, the investigators found no association between CIT and creatinine at 12 months when controlling for possible impactful predictors, such as age, kidney donor profile index, and BK virus status.


Fletchinger T, Burdine L. Impact of cold ischemia times on 1 year kidney transplant outcomes. Presented at: ATC 2022; June 4-8, 2022. Abstract 720.