Prolonged cold ischemia time obviates the benefits of 0 HLA mismatches in renal transplantation

Hypothesis: Recipients of 0 HLA mismatch kidneys with prolonged cold ischemia times of longer than 36 hours do not have superior outcomes compared with recipients of kidneys with 1 or more mismatches. Design: Retrospective review. Setting: Transplanation centers. Patients and Methods: A total of 63 688 recipients who underwent transplantation between January 1, 1990, and July 31, 1998. Main Outcome Measures: Delayed graft function, serum creatinine level, and patient and renal graft survival. Results: Recipients of 0 HLA mismatch kidneys with fewer than 36 hours of cold ischemia time had better 5-year graft survival (75%) when compared with recipients with 1 or more mismatches (67%) (P<.001). However, recipients of 0 HLA mismatch kidneys with longer than 36 hours of cold ischemia time did not have any graft survival advantage (71% in 0 HLA mismatch kidneys vs 72% in 1 or more mismatches, P=.24). Conclusions: Cold ischemia times of longer than 36 hours obviate the benefits of better graft survival conferred by better matching.