Causes of Prolonged Cold Ischemia Time After Arrival of Deceased Donor Kidney at Implanting Center: Results From a Prospective Audit
Year: 2025
Type: article
Study design: Observational Study
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.
Source: Clinical Transplantation
DOI: 10.1111/ctr.70227
Authors: Mariyam Mujeeb, Balint Borbas, Andrei Tanase, Bynvant Sandhu, Nicholas Barnett, Rhana Zakri, Dilan Dabare, Kamlesh Patel, Ugochukwu Okafor, Tobi Ayorinde, Abigail Chan, Suresh Hanji, Reza Motallebzadeh, Awad Alawad, Verity Brooker, Christopher Chalklin, Sapna Gupta, Laszlo Szabo, Ahmed Malik, Omer Mustafa, Abbas Ghazanfar, Haitham Soliman, Rowland Storey, Gintaras Petrosius, Khadija Tariq, Catherine Boffa, Rupesh Sutaria, Jeevan Gopal, Hussein Khambalia, Zia Moinuddin, Viswakumar Prabakaran, Rania Khattab, Aimen Amer, Laura Martin, Susannah Houston, Andrew Jackson, Sameh Mayaleh, Anna Rizzello, Sushma Shankar, Sanjay Sinha, Sachith Arachchige, Charalampos Konstantinou, Kama Muhammad, John O'Callaghan, Karim Hamaoui, Neil Russel, Somaiah Aroori
Institutions: Nottingham University Hospitals NHS Trust, Sherwood Forest Hospitals NHS Foundation Trust, University Hospitals Bristol and Weston NHS Foundation Trust, Guy's and St Thomas' NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Royal Free London NHS Foundation Trust, University Hospital of Wales, St George’s University Hospitals NHS Foundation Trust, Hammersmith Hospital, Portsmouth Hospitals NHS Trust, Manchester University NHS Foundation Trust, Newcastle upon Tyne Hospitals NHS Foundation Trust, Western Infirmary, Leicester General Hospital, University of Oxford, Oxford University Hospitals NHS Trust, University Hospitals Coventry and Warwickshire NHS Trust, Addenbrooke's Hospital, University Hospitals Plymouth NHS Trust
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4413005074