The need to reduce cold ischemia time in kidney transplantation

Hypothermic preservation is a prerequisite for kidney exchange in transplantation. The severity of tissue damage caused by hypothermic preservation influences the level of ischemia/reperfusion injury and subsequent graft function. With the purpose of reviewing the implications of prolonged cold ischemia time (CIT) in kidney transplantation, its pathophysiology, effects on early and late outcome of transplantation for different types of deceased organ donors, and preservation methods are discussed based on recent literature.

The main findings are that the consequences of a prolonged CIT are mainly identifiable in the early posttransplant period as delayed graft function, especially in expanded criteria donors, and possibly in an increased acute rejection rate. The preferred method of hypothermic preservation in expanded criteria donors and donors after cardiac death appears to be machine preservation.

The effects of CIT on the long-term outcome of renal transplantation in the form of impaired graft function and graft survival are less evident.