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Review
. 2022 Mar 15;11(6):1620.
doi: 10.3390/jcm11061620.

The Impact of Cold Ischaemia Time on Outcomes of Living Donor Kidney Transplantation: A Systematic Review and Meta-Analysis

Stijn C van de Laar  1   2 , Jeffrey A Lafranca  1 , Robert C Minnee  2 , Vassilios Papalois  1   3 , Frank J M F Dor  1   3
Affiliations
Review

The Impact of Cold Ischaemia Time on Outcomes of Living Donor Kidney Transplantation: A Systematic Review and Meta-Analysis

Stijn C van de Laar et al. J Clin Med. .

Abstract

Studies have been carried out to investigate the effect of a prolonged cold ischaemia time (CIT) on the outcomes of living donor kidney transplantation (LDKT). There is no clear consensus in the literature about the effects of CIT on LDKT outcomes, and therefore, we performed a systematic review and meta-analysis to provide evidence on this subject. Searches were performed in five databases up to 12 July 2021. Articles comparing different CIT in LDKT describing delayed graft function (DGF), graft and patient survival, and acute rejection were considered for inclusion. This study is registered with PROSPERO, CRD42019131438. In total, 1452 articles were found, of which eight were finally eligible, including a total of 164,179 patients. Meta-analyses showed significantly lower incidence of DGF (odds ratio (OR) = 0.61, p < 0.01), and significantly higher 1-year graft survival (OR = 0.72, p < 0.001) and 5-year graft survival (OR = 0.88, p = 0.04), for CIT of less than 4 h. Our results underline the need to keep CIT as short as possible in LDKT (ideally < 4 h), as a shorter CIT in LDKT is associated with a statistically significant lower incidence of DGF and higher graft survival compared to a prolonged CIT. However, clinical impact seems limited, and therefore, in LDKT programmes in which the CIT might be prolonged, such as kidney exchange programmes, the benefits outweigh the risks. To minimize these risks, it is worth considering including CIT in kidney allocation algorithms and in general take precautions to protect high risk donor/recipient combinations.

Keywords: cold ischemia time; kidney transplantation; living donors.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Review’s and Meta-Analysis) flowchart of the systematic review search.
Figure 2
Figure 2
The incidence of DGF for CIT shorter and longer than 4 h. CIT: cold ischaemia time; DGF: delayed graft function.
Figure 3
Figure 3
The incidence of DGF in 0–2 h (reference) of CIT versus 2–4, 4–6 and 6–8 h of CIT. CIT: cold ischaemia time; DGF: delayed graft function.
Figure 4
Figure 4
The incidence of DGF for 0–2, 2–4, 4–8 and 8+ hours of CIT. The studies included are Gill et al. [11], Krishnan et al. [30], Nath et al. [31] and Simpkins et al. [35]. CIT: cold ischaemia time; DGF: delayed graft function.
Figure 5
Figure 5
One-year graft survival for CIT shorter and longer than 4 h. CIT: cold ischaemia time.
Figure 6
Figure 6
One-year graft survival; CIT of 0–2 h (reference) versus 2–4 and 4–8 h of CIT. CIT: cold ischaemia time.
Figure 7
Figure 7
Five-year graft survival for CIT shorter and longer than 4 h. CIT: cold ischaemia time.
Figure 8
Figure 8
Five-year graft survival; CIT of 0–2 h (reference) versus 2–4 h and 4–8 h of CIT. CIT: cold ischaemia time.
Figure 9
Figure 9
Five-year graft survival hazard ratio; CIT of 0–2 h versus 2–4 h. CIT: cold ischaemia time.
Figure 10
Figure 10
Five-year graft survival hazard ratio; CIT of 0–2 h versus 4–8 h. CIT: cold ischaemia time.
Figure 11
Figure 11
Ten-year graft survival for CIT shorter and longer than 4 h. CIT: cold ischaemia time.
Figure 12
Figure 12
One-year patient survival for CIT shorter and longer than 4 h. CIT: cold ischaemia time.
Figure 13
Figure 13
Five-year patient survival for CIT shorter and longer than 4 h. CIT: cold ischaemia time.
Figure 14
Figure 14
The incidence of acute rejection for CIT shorter and longer than 4 h. CIT: cold ischaemia time.
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