ORGAN DONATION AND ALLOCATION II

J. Fan¹, J. Sageshima¹, G. Ciancio¹, J.J. Gaynor¹, J. Sageshima¹, L. Chen¹, D.A. Grant², T. Urahashi¹, R. Brown¹, A. Mattiazzi², G. Guerra², W. Kupin², D. Roth², S. Ganz², P. Ruiz², G.W. Burke, iii^1
1Surgery, Kidney/pancreas Transplant, University of Miami Miller School of Medicine, Miami/UNITED STATES OF AMERICA, ²Miller School Of Medicine, University of Miami, Miami/UNITED STATES OF AMERICA

Body: Introduction: Double kidney transplantation from very marginal donors can increase the number of recipients who benefit from transplantation utilizing otherwise discarded kidneys. However, refusals by multiple transplant centers/recipients and more detailed assessments (e.g. pre-implantation histology) can prolong cold ischemia time (CIT).
Methods: To assess the impact of prolonged CIT, we retrospectively evaluated 72 consecutive recipients (Dec. 2004 to Dec. 2008) who received double kidney grafts that were deemed to be not suitable for single kidney transplantation. Two groups with long CIT (L-CIT: > 36 hr, n=24) and short CIT (S-CIT: ≤ 36 hr, n=48) were compared. All grafts were evaluated by histology and preserved on pulsatile machine perfusion (PP). T-cell depleting antibody induction and tacrolimus and mycophenolate (± steroids) based maintenance immunosuppressant were used.
Results: Overall, CIT was relatively long (median 33.0 hr [15.8 - 51.7 hr]); 63 patients (87.5%) had CIT > 24 hr and 5 patients (6.9%) had CIT > 48 hr. Baseline characteristics were similar with regard to donor age, history of hypertension, terminal creatinine, PP flow, PP resistance, and percent glomerulosclerosis. As expected, total CIT (pre-PP time + PP time) was longer in the L-CIT group than in the S-CIT group (43.2 ± 4.7 hr vs. 28.8 ± 5.0 hr, p < 0.0001); however, pre-PP (simple storage) time was similar (6.0 ± 2.5 hr vs. 5.7 ± 2.1 hr, p=0.658). The incidence of delayed graft function (requiring dialysis within 1 week post-transplant) was numerically (but not statistically) higher in the L-CIT group (4.2% vs. 2.1%, p=1.00), which did not lead to any adverse outcomes thereafter. Two-year death-censored graft survival was not different (L-CIT: 91.5% vs. S-CIT: 93.2%, p=0.696). Estimated GFR at 1 year post-transplant was similar (L-CIT: 68.7 ± 34.5 vs. S-CIT: 59.0 ± 27.0 mL/min/1.73 m², p=0.235), and the percentage of patients with poor graft function (estimated GFR < 30 mL/min/1.73 m²) at 1 year was also similar (12.5% vs. 10.4%).
Conclusion: Despite prolonged CIT (up to 48 hours), double kidney transplantation can provide reasonable graft survival and renal graft function when preserved by PP. These grafts should not be discarded based on merely prolonged ischemia time.

Disclosure: All authors have declared no conflicts of interest.