Prolonged Cold Ischemia Time Obviates the Benefits of 0 HLA Mismatches in Renal Transplantation

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Abstract
AGGRESSIVE PROMOTION of organ donation has resulted in a steady increase in donors but, unfortunately, the disparity between the number of organs available and the number of patients awaiting transplantation continues to increase.1 The waiting time for organs doubled from an average of 400 days in 1988 to 842 days in 1994 and regional differences in waiting time vary significantly.1 Because regional discrepancies in waiting time are due to the sharing of kidneys on a regional basis, national sharing to ameliorate the perceived inequity of disparate waiting times has been proposed. Only "perfectly matched" kidneys are shared nationally because of the superior outcome attained with better matching. However, national sharing of kidneys tends to result in prolonged transport and cold ischemia times (CITs) that have been shown to compromise renal function. To determine the effect of both prolonged CIT and degree of HLA match on renal transplantation outcome, the United Network of Organ Sharing/Scientific Registry patient data were reviewed.