Causes of Prolonged Cold Ischemia Time After Arrival of Deceased Donor Kidney at Implanting Center: Results From a Prospective Audit.
Mujeeb M., Borbas B., Tanase A., Sandhu B., Barnett N., Zakri R., Dabare D., Patel K., Okafor U., Ayorinde T., Chan A., Hanji S., Motallebzadeh R., Alawad A., Brooker V., Chalklin C., Gupta S., Szabo L., Malik A., Mustafa O., Ghazanfar A., Soliman H., Storey R., Petrosius G., Tariq K., Boffa C., Sutaria R., Gopal J., Khambalia H., Moinuddin Z., Prabakaran V., Khattab R., Amer A., Martin L., Houston S., Jackson A., Mayaleh S., Rizzello A., Shankar S., Sinha S., Arachchige S., Konstantinou C., Muhammad K., O'Callaghan J., Hamaoui K., Russel N., Aroori S.
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.