COLD ISCHEMIA AND OUTCOME IN 17,937 CADAVERIC KIDNEY-TRANSPLANTS

To determine if cold preservation time continues to affect renal trans plant outcome, prospectively collected data from 17,937 cadaveric rena l transplants performed between 1982 and 1991 were analyzed. Cold pres ervation intervals of 1-16, 16-32, 32-48, and greater than 48 hr were studied by multi- and univariate methods for two time periods: 1982-19 89 (n = 13800) and 1990-1991 (n = 4137). The functional one-year graft survival for kidneys stored over different intervals was significantl y different (P < 0.001) only for the 1982-1989 epoch: one-year allogra ft survival ranged from 76% (1-16), to 72% (16-32 and 32-48) to 74% (> 48) hr. One-year graft survival ranged from 81 to 83% for the four pr eservation times in 1990 through 1991 (P = NS), Overall actuarial graf t survival was 76% (74% prior to 1990, and 82% after 1990), Factors si gnificantly (P < 0.0001) affecting kidney transplant outcome before an d after 1990 were delayed graft function (DGF): n = 4232, 65% one-year graft survival; retransplant status: n = 3029, 67% one-year graft sur vival; and HLA match at three or more loci: n = 6067, 79% one-year gra ft survival. While DGP occurred more often with prolonged preservation , kidneys with DGF had similar survival regardless of preservation dur ation. Before 1990, pretransplant transfusion was associated with bett er and black recipient race with worse outcome; neither transfusion no r recipient race had any effect after 1990. Patients receiving kidneys preserved for longer periods demonstrate one-year graft survival comp arable to kidneys preserved for shorter periods. Prolonged cold ischem ic time should no longer be a principal reason for considering organ d iscard.