LAUSR

Prolonged warm (WIT) and cold (CIT) ischemia times are often important considerations in the discard of DCD kidneys, but their impact on post‐transplant outcomes in the post‐KAS era is unclear. We examined the association of ischemia time on delayed graft function (DGF) and death‐censored graft failure for DCD kidneys. The 2018 SRTR SAF was utilized to identify post‐KAS DCD kidney transplants occurring from 2015 to 2018. Relative risk and Cox regression were used to calculate risk of delayed graft function and hazard of death‐censored graft failure, respectively. We identified 4,680 kidneys from DCD donors transplanted from 2015 to 2018 with recorded WIT and CIT times. Median WIT was 21.0 minutes (IQR 14.0‐28.0), and CIT was 18.5 hours (IQR 13.9‐23.5). The overall incidence of DGF was 42.7%. In a univariable relative risk regression model, extended CIT (24‐30 hours:RR 1.37, 95% CI 1.15‐1.77; >30 hours:RR 1.47, 95% CI 1.22‐1.77) and WIT (20‐40 minutes:RR 1.10, 95% CI 1.03‐1.17) were associated with increased risk of DGF. When included in a multivariable model, neither prolonged CIT nor WIT were significantly associated with death‐censored graft failure. Prolonged WIT and CIT are associated with increased DGF but not death‐censored graft failure in recipients of DCD kidney transplants in the post‐KAS era. Extended ischemia alone should not be used as a basis for discard or non‐utilization of these organs.