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Long Cold Ischemia Times in Same Hospital Deceased Donor Transplants
Eric K Chow1, Sandra DiBrito1, Xun Luo1
1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
Organ sharing policies increased cold ischemia time (CIT) in liver and kidney transplants. Same-hospital transplants also show significant CIT, influenced by donor factors, recipient characteristics, and transplant center variations.
Area of Science:
- Transplantation Medicine
- Organ Allocation Systems
- Surgical Outcomes
Background:
- Recent organ allocation policy changes (Share-35 for livers, Kidney Allocation System for kidneys) promote broader organ sharing.
- Broader organ sharing and other factors have led to increased cold ischemia time (CIT) in deceased donor transplants.
- Understanding CIT drivers is crucial for optimizing organ utilization and transplant success.
Purpose of the Study:
- To analyze cold ischemia time (CIT) in same-hospital liver transplants (SHLT) and same-hospital kidney transplants (SHKT).
- To identify factors associated with increased CIT in SHLT and SHKT.
- To examine variations in CIT across Organ Procurement Organizations and transplant centers.
Main Methods:
- Retrospective registry study analyzing SHLT (n=4347) and SHKT (n=9707) data from 2004-2014.
- Comparison of CIT between same-hospital and other-hospital transplants.
- Statistical analysis to identify factors influencing CIT, including donor characteristics, recipient factors, and transplant center variables.
Main Results:
- SHLT median CIT was 5.0 hours vs. 6.6 hours for other-hospital LT; SHKT median CIT was 13.0 hours vs. 16.5 hours for other-hospital KT.
- Factors associated with increased CIT in SHLT included donation after circulatory death, donor biopsy, male recipients, and recipient obesity.
- Significant variations in CIT were observed across transplant centers for both SHLT and SHKT, with center median CIT ranging widely.
Conclusions:
- Same-hospital transplants incur substantial cold ischemia time, independent of inter-hospital organ transport.
- Donor characteristics, recipient factors, and transplant center practices significantly impact CIT in both liver and kidney transplants.
- Addressing variations in CIT within transplant centers is essential for improving organ transplant outcomes.
Background:
Recent changes in deceased donor organ allocation for livers (Share-35) and kidneys (kidney allocation system) have resulted in broader sharing of organs and increased cold ischemia time (CIT). Broader organ sharing however is not the only cause of increased CIT.
Methods:
This was a retrospective registry study of CIT in same-hospital liver transplants (SHLT, n = 4347) and same-hospital kidney transplants (SHKT, n = 9707) between 2004 and 2014.
Results:
In SHLT, median (interquartile range) CIT was 5.0 (3.5-6.5) hours versus 6.6 (5.1-8.4) hours in other-hospital LT. donation after circulatory death donors, donor biopsy, male recipient, recipient obesity, and previous transplant were associated with increased CIT. Model for End-Stage Liver Disease at transplant of 29+ or status 1a was associated with decreased CIT. SHLT CIT varied by Organ Procurement Organization and transplant-center (P < 0.01), with center median CIT ranging from 2.0 to 7.8 hours across 118 centers. In SHKT, CIT was 13.0 (8.5-19.0) hours versus 16.5 (11.3-22.6) hours in other-hospital KT. Overweight donors, donation after cardiac death donors, right-kidney, donor biopsy, recipient obesity, use of mechanical perfusion, additional KT procedures on the same day, and transplant center annual volume were associated with increased CIT. Older donor age, extended criteria donors, and underweight recipients were associated with decreased CIT. SHKT CIT varied by Organ Procurement Organization and transplant-center (P < 0.001), with center median CIT ranging from 3.3 to 29 hours across 206 centers. Transplant centers with longer SHKT also had longer SHLT (P = 0.01).
Conclusions:
Same-hospital transplants already have a significant amount of CIT, even without transporting the organ to another hospital.
