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Multicenter Study
. 2025 Aug;39(8):e70227.
doi: 10.1111/ctr.70227.

Causes of Prolonged Cold Ischemia Time After Arrival of Deceased Donor Kidney at Implanting Center: Results From a Prospective Audit

Mariyam Mujeeb  1 , Balint Borbas  2 , Andrei Tanase  3 , Bynvant Sandhu  4 , Nicholas Barnett  4 , Rhana Zakri  4 , Dilan Dabare  5 , Kamlesh Patel  5 , Ugochukwu Okafor  5 , Tobi Ayorinde  6 , Abigail Chan  6 , Suresh Hanji  6 , Reza Motallebzadeh  6 , Awad Alawad  7 , Verity Brooker  7 , Christopher Chalklin  7 , Sapna Gupta  7 , Laszlo Szabo  7 , Ahmed Malik  8 , Omer Mustafa  8 , Abbas Ghazanfar  8 , Haitham Soliman  9 , Rowland Storey  9 , Gintaras Petrosius  10 , Khadija Tariq  10 , Catherine Boffa  10 , Rupesh Sutaria  10 , Jeevan Gopal  11 , Hussein Khambalia  11 , Zia Moinuddin  11 , Viswakumar Prabakaran  12 , Rania Khattab  12 , Aimen Amer  12 , Laura Martin  13 , Susannah Houston  13 , Andrew Jackson  13 , Sameh Mayaleh  14 , Anna Rizzello  14 , Sushma Shankar  15 , Sanjay Sinha  15 , Sachith Arachchige  16 , Charalampos Konstantinou  16 , Kama Muhammad  16 , John O'Callaghan  16 , Karim Hamaoui  17 , Neil Russel  17 , Somaiah Aroori  18
Affiliations
Multicenter Study

Causes of Prolonged Cold Ischemia Time After Arrival of Deceased Donor Kidney at Implanting Center: Results From a Prospective Audit

Mariyam Mujeeb et al. Clin Transplant. 2025 Aug.

Abstract

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.

Keywords: DBD; DCD; cold ischemia time; crossmatch; graft function; transplant.

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References

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