Delayed Kidney Transplantation After 83 Hours of Cold Ischemia Time In Combined Liver-Kidney Transplant

The field of kidney transplantation (KTx) has evolved with hypothermic machine perfusion (HMP) to extend the time between procurement and transplant expanding the shipping distance (e.g. East-to-West coast in the U.S.).

Summary

The field of kidney transplantation (KTx) has evolved with hypothermic machine perfusion (HMP) to extend the time between procurement and transplant expanding the shipping distance (e.g. East-to-West coast in the U.S.). HMP also enabled to limit the harmful effect of cold ischemia time (CIT), therefore, decreased the rate of delayed graft function (DGF).¹ Studies on long-term effects of CIT showed proportional increase in DGF and graft failure with each hour of CIT.² In case of combined liver-kidney transplantation (CLKTx), the recipient is critically ill with coagulopathy, hyperbilirubinemia, and on pressor(s) support immediately after liver transplantation (LTx), creating an unfavorable hostile environment for the kidney allograft. Therefore, it is preferable that KTx is delayed with the support of HMP.3 We previously showed a novel approach of delaying the kidney portion of CLKTx in a cohort of 61 patients with a mean CIT of 50 hours (range 20-81 hours) with excellent outcomes in patient survival.^3,4 Our studies confirmed that DGF is the most important negative predictor of patient survival in this complex group of patients.