Allografts flown coast-to-coast were transplanted successfully despite prolonged cold ischemia.

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.

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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 in 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, who underwent a laparoscopic donor nephrectomy at the 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 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 mg/dL, 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, they 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.”