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Updated: Aug 13, 2025
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Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
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Outcomes of DCD kidneys with CIT-induced delayed graft function
Nikolas H Zaphiros1,2, Jing Nie3, Michael W Alchaer4
1Department of Surgery, University at Buffalo, Buffalo, New York, USA.
Clinical Transplantation
|January 24, 2023
Summary
Longer cold ischemia time (CIT) in donation after circulatory death (DCD) kidney transplants significantly increases the risk of delayed graft function (DGF) and negatively impacts long-term graft survival. This highlights the critical role of ischemia duration in DCD kidney outcomes.
Area of Science:
- Nephrology
- Transplantation immunology
- Organ preservation
Background:
- Donation after circulatory death (DCD) kidney grafts face warm ischemia challenges.
- Cold ischemia time (CIT) further exacerbates injury, potentially leading to delayed graft function (DGF) and reduced graft survival.
- Understanding the impact of CIT on DCD kidney outcomes is crucial for improving transplantation success.
Purpose of the Study:
- To analyze the risk of CIT-induced DGF on DCD kidney outcomes.
- To evaluate the dose-dependent effect of CIT differences on graft survival in paired DCD kidney recipients.
- To assess the association between CIT and acute rejection rates.
Main Methods:
- Utilized national data from adult kidney-only recipients of paired DCD kidneys between 2008 and 2018.
- Compared outcomes between recipients where one kidney experienced DGF and the other did not.
- Performed multivariate analysis to assess the impact of varying CIT differences on graft survival and acute rejection.
Main Results:
- Increasing CIT differences showed a significant dose-dependent effect on overall graft survival.
- Graft survival risk became significant at CIT differences of ≥10-h (aHR 1.37) and ≥15-h (aHR 1.78).
- No statistically significant differences in acute rejection rates were observed across different delta-CIT levels.
Conclusions:
- Prolonged CIT in DCD kidney transplantation significantly mediates DGF.
- CIT is a critical factor impacting long-term graft outcomes in DCD kidney recipients.
- Minimizing CIT is essential for improving DCD kidney transplant success.
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