Logistical Factors influencing Cold Ischaemia Times In Deceased Donor Kidney Transplants

Background: Prolonged cold ischaemia time (CIT) is associated with a significant risk of short and long-term graft failure in deceased donor (DD) kidney transplants across the world. The aim of this prospective longitudinal study was to determine the importance of logistical factors on CIT. Method: Data on 1763 transplants were collected prospectively over 14 months from personnel in 16 transplant centres, 19 Histocompatibility and Immunogenetics laboratories, transport providers and NHS Blood and Transplant (NHSBT). Results: The overall mean CIT was 13.8 hours, with significant centre variation (p<0.0001). Factors that significantly reduced CIT were donation following circulatory death (DCD)(p=0.03), shorter transport time (p=0.0002), use of virtual crossmatch p<0.0001) and use of donor blood for pre-transplant crossmatch (p<0.0001). CIT for transplants that went ahead with a virtual crossmatch was 3 hours shorter than those requiring a pre-transplant crossmatch (p<0.0001). There was a mean delay of 3 hours in starting transplants despite organ, recipient and pre-transplant XM result being ready, suggesting that theatre access contributes significantly to increased CIT. Discussion: This study identifies logistical factors relating to donor, transport, crossmatching, recipient and theatre that impact significantly on CIT in DD renal transplantation, some of which are modifiable; attention should be focussed on addressing all of these.