Prolonged cold ischemia time obviates the benefits of 0 HLA mismatches in renal transplantation

HYPOTHESIS: Recipients of 0 HLA mismatch kidneys with prolonged cold ischemia times of longer than 36 hours do not have superior outcomes compared with recipients of kidneys with 1 or more mismatches. DESIGN: Retrospective review. SETTING: Transplanation centers. PATIENTS AND METHODS: A total of 63,688 recipients who underwent transplantation between January 1, 1990, and July 31, 1998. MAIN OUTCOME MEASURES: Delayed graft function, serum creatinine level, and patient and renal graft survival. RESULTS: Recipients of 0 HLA mismatch kidneys with fewer than 36 hours of cold ischemia time had better 5-year graft survival (75%) when compared with recipients with 1 or more mismatches (67%) (P<.001). However, recipients of 0 HLA mismatch kidneys with longer than 36 hours of cold ischemia time did not have any graft survival advantage (71% in 0 HLA mismatch kidneys vs 72% in 1 or more mismatches, P =.24). CONCLUSIONS: Cold ischemia times of longer than 36 hours obviate the benefits of better graft survival conferred by better matching.