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Sequential Kidney Transplants from Deceased Donors: Does the Increased Cold Ischemia Time Change the Final Outcome?
Evangelos Messaris, Amitabh Gautam, Reginald Gohh, Angelito Yango, Anthony Monaco, Paul Morrissey
Brown University, Providence, RI

Objective: A deceased donor provides two kidneys for transplantation, often at the same center, resulting in sequential transplants. We investigated whether the second recipient assumes greater risk for delayed allograft function or suffers any penalty due to the prolonged cold ischemic time (CIT).
Design: Retrospective study.
Setting: Division of Transplantation in an academic medical center.
Patients: 152 patients underwent paired kidney transplantation from 76 deceased kidney donors from1997 - 2006.
Interventions: Two kidneys from each deceased donor were transplanted in consecutive procedures (Groups A and B). The order of surgery was pre-determined by waiting time and hence random; the second kidney transplanted (Group B) sustained an increased CIT.
Main Outcome Measures: Delayed graft function, graft survival, postoperative complications, length of hospital stay and patient survival.
Results: Patients that received the second kidney from each donor had an increased cold ischemia time (16.6±6.1 hours) compared to the first-organ recipients (11.2±5.3 hours, p<0.001). The increase in the cold ischemia time had no effect in the incidence of delayed graft function (25% in each group), graft survival (1296±948 vs. 1366±1007 days, p=0.66), length of stay (8.9±4.4 vs. 7.7±3.4 days) and 3-year survival time (87.3% vs. 82.8%, p=0.62). Of interest, delayed allograft function was concordant in 52% of cases, and occurred with equal frequency in either the first or second transplanted kidney (9/76 cases each) when one kidney functioned promptly and the other in delayed fashion.
Conclusions: Sequential kidney transplantations from deceased donors, although they necessitate increased CIT for one recipient, are safe and do not effect outcomes.


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