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Causes of Prolonged Cold Ischemia Time After Arrival of Deceased Donor Kidney at Implanting Center: Results From a Prospective Audit

Mujeeb, Mariyam; Borbas, Balint; Tanase, Andrei; Sandhu, Bynvant; Barnett, Nicholas; Zakri, Rhana; Dabare, Dilan; ... Aroori, Somaiah; + view all (2025) Causes of Prolonged Cold Ischemia Time After Arrival of Deceased Donor Kidney at Implanting Center: Results From a Prospective Audit. Clinical Transplantation , 39 (8) , Article e70227. 10.1111/ctr.70227.

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Abstract

BACKGROUND: Deceased donor kidney transplants often face delays, leading to prolonged cold ischemia time (CIT), yet data on post-allograft arrival delays are scarce. OBJECTIVES: This audit aims to identify and characterize the delays contributing to CIT prolongation after allograft arrival at the implanting center. DESIGN: Data was collected prospectively from 14 UK centers between February and September 2022. Timelines from allograft arrival to the implanting center to implantation were recorded for adult deceased donor kidney-only transplants. RESULTS: The median CIT for all 446 allografts [(donation after cardiac death (DCD), 48.2% and donation after brain death (DBD), 51.6%)] was 11:08 h (interquartile range (IQR): 08:15–15:12). A total of 42% of DCD and 15% of DBD allografts exceeded the national recommended duration of 12 and 18 h, respectively. CIT was prolonged in centers with dedicated transplant theaters, with a median CIT of 13:41 (IQR: 08:11–15:13) compared to a median CIT of 09:43 (IQR: 07:36–12:29) hours (p < 0.005, 95% CI: −4.40, −2.60) in centers without dedicated transplant theaters. Compared to full cross-match (FXM) results, a higher proportion of Virtual cross-match (VXM) results (75.2% vs. 89.4%, Odds Ratio (OR): 2.79, CI: 1.57–5.0, p < 0.005) were available before the allograft arrived at the implanting center. The proportion of crossmatch results available before the recipient's arrival at the implanting center was 31.7% (46.6% for VXM vs. 4.9% for FXM, OR: 16.76, CI: 7.50, 44.17, p < 0.005). However, no difference was found in CIT between the VXM (median: 11:06, IQR: 08:14–15:20) and FXM (median: 11:00, IQR: 08:34–14:56) groups (p = 0.75, CI: −0.75, 1.02). Qualitative analysis identified theater and staff unavailability as common reasons for delay. CONCLUSION: Internal center practices have a significant impact on CIT, necessitating intervention to optimize transplant outcomes.

Type: Article
Title: Causes of Prolonged Cold Ischemia Time After Arrival of Deceased Donor Kidney at Implanting Center: Results From a Prospective Audit
DOI: 10.1111/ctr.70227
Publisher version: https://doi.org/10.1111/ctr.70227
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Surgical Biotechnology
URI: https://discovery.ucl.ac.uk/id/eprint/10212417
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