Influence of prolonged cold ischemia in renal transplantation

Aim: To determine to what extent current cold ischemia times (CITs) affect the results of renal transplantation in the Netherlands. Methods: Retrospective survey of the Dutch Organ Transplant Registry concerning transplants from deceased donors between 1990 and 2007. Results: A total of 6322 recipients were identified, of whom 5306 received a kidney from deceased heartbeating (HBD) and 1016 from donors after cardiac death (DCD). Mean CIT was 24.0 +/- 7.9 h in HBD and 21.6 +/- 6.7 h in DCD. The percentage delayed graft function (DGF) was 12.3 and 50.4, respectively (p < 0.001). Primary non-function (PNF) occurred in, respectively, 1.7% and 5.0% (p < 0.001). Serum creatinine after three months was 166 mu M in HBD and 213 mu M in DCD (p < 0.001). Five-yr graft survival was 79.5% and 78.3%, respectively (p = ns). In multivariate analysis, CIT proved to be an independent risk factor for DGF and PNF. Shorter CIT was associated with better graft survival in both groups with a hazard ratio of 1.024 (1.011-1.037, 95% CI)/h. CIT < 20 h was associated with a graft survival benefit of 3% after five yr in HBD and CIT of < 16 h with a benefit of 10% in DCD. Conclusions: Longer CITs are associated with the occurrence of DGF, PNF and decreased graft survival in the Netherlands.