Causes of Prolonged Cold Ischemia Time After Arrival of Deceased Donor Kidney at Implanting Center: Results From a Prospective Audit.
作者信息
Mujeeb Mariyam, Borbas Balint, Tanase Andrei, Sandhu Bynvant, Barnett Nicholas, Zakri Rhana, Dabare Dilan, Patel Kamlesh, Okafor Ugochukwu, Ayorinde Tobi, Chan Abigail, Hanji Suresh, Motallebzadeh Reza, Alawad Awad, Brooker Verity, Chalklin Christopher, Gupta Sapna, Szabo Laszlo, Malik Ahmed, Mustafa Omer, Ghazanfar Abbas, Soliman Haitham, Storey Rowland, Petrosius Gintaras, Tariq Khadija, Boffa Catherine, Sutaria Rupesh, Gopal Jeevan, Khambalia Hussein, Moinuddin Zia, Prabakaran Viswakumar, Khattab Rania, Amer Aimen, Martin Laura, Houston Susannah, Jackson Andrew, Mayaleh Sameh, Rizzello Anna, Shankar Sushma, Sinha Sanjay, Arachchige Sachith, Konstantinou Charalampos, Muhammad Kama, O'Callaghan John, Hamaoui Karim, Russel Neil, Aroori Somaiah
机构信息
Nottingham University Hospitals NHS Trust, Nottingham, UK.
Sherwood Forest Hospitals Trust, Sutton-in-Ashfield, UK.
出版信息
Clin Transplant. 2025 Aug;39(8):e70227. doi: 10.1111/ctr.70227.
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.
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