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

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

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
, Balint Borbas
, Andrei Tanase
, Bynvant Sandhu
, Nicholas Barnett
, Rhana Zakri
, Dilan Dabare
, Kamlesh Patel
, Ugochukwu Okafor
, Tobi Ayorinde
, Abigail Chan
, Suresh Hanji
, Reza Motallebzadeh
, Awad Alawad
, Verity Brooker
, Christopher Chalklin
, Sapna Gupta
, Laszlo Szabo
, Ahmed Malik
, Omer Mustafa

Abbas Ghazanfar, Haitham Soliman, Rowland Storey, Gintaras Petrosius, Khadija Tariq, Catherine Boffa, Rupesh Sutaria, Jeevan Gopal, Hussein Khambalia, Zia Moinuddin, Viswakumar Prabakaran, Rania Khattab, Aimen Amer, Laura Martin, Susannah Houston, Andrew Jackson, Sameh Mayaleh, Anna Rizzello, Sushma Shankar, Sanjay Sinha, Sachith Arachchige, Charalampos Konstantinou, Kama Muhammad, John O'Callaghan, Karim Hamaoui, Neil Russel, Somaiah Aroori

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Pages (from-to)	e70227
Journal	Clinical Transplantation
Volume	39
Issue number	8
DOIs	https://doi.org/10.1111/ctr.70227
Publication status	Published - Aug 2025
Externally published	Yes

Keywords

Humans
Kidney Transplantation
Cold Ischemia/adverse effects
Prospective Studies
Male
Female
Middle Aged
Tissue Donors/supply & distribution
Graft Survival
Adult
Tissue and Organ Procurement
Follow-Up Studies
Prognosis
Risk Factors
Organ Preservation/methods
Time Factors
United Kingdom

Access to Document

10.1111/ctr.70227

Cite this

Mujeeb, M., Borbas, B., Tanase, A., Sandhu, B., Barnett, N., Zakri, R., Dabare, D., Patel, K., Okafor, U., Ayorinde, T., Chan, A., Hanji, S., Motallebzadeh, R., Alawad, A., Brooker, V., Chalklin, C., Gupta, S., Szabo, L., Malik, A., ... Aroori, S. (2025). Causes of Prolonged Cold Ischemia Time After Arrival of Deceased Donor Kidney at Implanting Center: Results From a Prospective Audit. Clinical Transplantation, 39(8), e70227. https://doi.org/10.1111/ctr.70227

@article{34317b8d588e4b71b3eb1eb4ba31f58f,

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

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 = "Humans, Kidney Transplantation, Cold Ischemia/adverse effects, Prospective Studies, Male, Female, Middle Aged, Tissue Donors/supply \& distribution, Graft Survival, Adult, Tissue and Organ Procurement, Follow-Up Studies, Prognosis, Risk Factors, Organ Preservation/methods, Time Factors, United Kingdom",

author = "Mariyam Mujeeb and Balint Borbas and Andrei Tanase and Bynvant Sandhu and Nicholas Barnett and Rhana Zakri and Dilan Dabare and Kamlesh Patel and Ugochukwu Okafor and Tobi Ayorinde and Abigail Chan and Suresh Hanji and Reza Motallebzadeh and Awad Alawad and Verity Brooker and Christopher Chalklin and Sapna Gupta and Laszlo Szabo and Ahmed Malik and Omer Mustafa and Abbas Ghazanfar and Haitham Soliman and Rowland Storey and Gintaras Petrosius and Khadija Tariq and Catherine Boffa and Rupesh Sutaria and Jeevan Gopal and Hussein Khambalia and Zia Moinuddin and Viswakumar Prabakaran and Rania Khattab and Aimen Amer and Laura Martin and Susannah Houston and Andrew Jackson and Sameh Mayaleh and Anna Rizzello and Sushma Shankar and Sanjay Sinha and Sachith Arachchige and Charalampos Konstantinou and Kama Muhammad and John O'Callaghan and Karim Hamaoui and Neil Russel and Somaiah Aroori",

note = "{\textcopyright} 2025 John Wiley \& Sons A/S. Published by John Wiley \& Sons Ltd.",

year = "2025",

month = aug,

doi = "10.1111/ctr.70227",

language = "English",

volume = "39",

pages = "e70227",

journal = "Clinical Transplantation",

issn = "0902-0063",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "8",

}

Mujeeb, M, Borbas, B, Tanase, A, Sandhu, B, Barnett, N, Zakri, R, Dabare, D, Patel, K, Okafor, U, Ayorinde, T, Chan, A, Hanji, S, Motallebzadeh, R, Alawad, A, Brooker, V, Chalklin, C, Gupta, S, Szabo, L, Malik, A, Mustafa, O, Ghazanfar, A, Soliman, H, Storey, R, Petrosius, G, Tariq, K, Boffa, C, Sutaria, R, Gopal, J, Khambalia, H, Moinuddin, Z, Prabakaran, V, Khattab, R, Amer, A, Martin, L, Houston, S, Jackson, A, Mayaleh, S, Rizzello, A, Shankar, S, Sinha, S, Arachchige, S, Konstantinou, C, Muhammad, K, O'Callaghan, J, Hamaoui, K, Russel, N & Aroori, S 2025, 'Causes of Prolonged Cold Ischemia Time After Arrival of Deceased Donor Kidney at Implanting Center: Results From a Prospective Audit', Clinical Transplantation, vol. 39, no. 8, pp. e70227. https://doi.org/10.1111/ctr.70227

TY - JOUR

T1 - Causes of Prolonged Cold Ischemia Time After Arrival of Deceased Donor Kidney at Implanting Center

T2 - Results From a Prospective Audit

AU - Mujeeb, Mariyam

AU - Borbas, Balint

AU - Tanase, Andrei

AU - Sandhu, Bynvant

AU - Barnett, Nicholas

AU - Zakri, Rhana

AU - Dabare, Dilan

AU - Patel, Kamlesh

AU - Okafor, Ugochukwu

AU - Ayorinde, Tobi

AU - Chan, Abigail

AU - Hanji, Suresh

AU - Motallebzadeh, Reza

AU - Alawad, Awad

AU - Brooker, Verity

AU - Chalklin, Christopher

AU - Gupta, Sapna

AU - Szabo, Laszlo

AU - Malik, Ahmed

AU - Mustafa, Omer

AU - Ghazanfar, Abbas

AU - Soliman, Haitham

AU - Storey, Rowland

AU - Petrosius, Gintaras

AU - Tariq, Khadija

AU - Boffa, Catherine

AU - Sutaria, Rupesh

AU - Gopal, Jeevan

AU - Khambalia, Hussein

AU - Moinuddin, Zia

AU - Prabakaran, Viswakumar

AU - Khattab, Rania

AU - Amer, Aimen

AU - Martin, Laura

AU - Houston, Susannah

AU - Jackson, Andrew

AU - Mayaleh, Sameh

AU - Rizzello, Anna

AU - Shankar, Sushma

AU - Sinha, Sanjay

AU - Arachchige, Sachith

AU - Konstantinou, Charalampos

AU - Muhammad, Kama

AU - O'Callaghan, John

AU - Hamaoui, Karim

AU - Russel, Neil

AU - Aroori, Somaiah

PY - 2025/8

Y1 - 2025/8

N2 - 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.

AB - 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.

KW - Humans

KW - Kidney Transplantation

KW - Cold Ischemia/adverse effects

KW - Prospective Studies

KW - Male

KW - Female

KW - Middle Aged

KW - Tissue Donors/supply & distribution

KW - Graft Survival

KW - Adult

KW - Tissue and Organ Procurement

KW - Follow-Up Studies

KW - Prognosis

KW - Risk Factors

KW - Organ Preservation/methods

KW - Time Factors

KW - United Kingdom

U2 - 10.1111/ctr.70227

DO - 10.1111/ctr.70227

M3 - Article

C2 - 40767342

SN - 0902-0063

VL - 39

SP - e70227

JO - Clinical Transplantation

JF - Clinical Transplantation

IS - 8

ER -

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

Abstract

Keywords

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