Effects of Cold Ichemic Time on Allograft Survival in Kidney Transplantation From Expanded Criteria Donor

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Backgrounds Kidney organ shortage is a major problem for transplant communities around the world. Kidneys from expanded criteria donors (ECD) is increasingly accepted and widely used by many transplant programs. However, kidney allograft survivals from ECD is believed to be lower compared to standard criteria donors (SCD) due to lower nephron numbers. Objectives To demonstrate factors correlated with poor allograft survival from ECD. Methods Using Thai transplantation registry data from 1994 to 2016, 2,886 adults (>18 years) first deceased donor kidney transplant recipients were included into the study. Of those, 242 (8.39%) were kidney transplantation from expanded criteria donor which was defined as donor age of more than 60 year or donor age between 50 to 60 years with two of the following characteristics including history of hypertension, last serum creatinine of more than 1.5 mg/dl, and death from stroke. Results Mean recipient age and donor age were significantly higher in ECD group (for recipient age, 48.6±11.8 vs 44.7±11.3 years in SCD group, p<0.001; for donor age, 60.1±5.7 vs 34.5±13.0 years in SCD group, p<0.001). Not surprisingly, cold ischemic time (CIT) is longer in ECD group (20.2±5.0 vs 19.0±6.5 hours in SCD group, p=0.006) and delayed graft function is higher (59.7% vs 42.4%, p<0.001). ECD group increased risk of allograft loss when compared to SCD group (HR 2.19, 95% CI 1.65 to 2.91, p <0.001). However, in patients with CIT of less than 18 hours, the effects of ECD was disappeared (HR 1.58, 95% CI 0.83 to 3.01, p=0.165), compared to group of patients with CIT of more than 18 hours (HR 2.29, 95% CI 1.61 to 3.24, p <0.001) as shown in the figure. Conclusions Kidney transplantation from ECD increases the risk of allograft failure. However, this effect is vanished if CIT is less than 18 hours. Transplant coordinators from 31 kidney transplant centers across Thailand.