To determine the effect of cold ischaemia time (CIT) on the outcome of cadaveric renal transplantation in the Netherlands.

Retrospective, comparative.

We studied data from the Netherlands organ transplant registry of cadaveric renal transplants from 1990-2007.

6322 cadaveric renal transplant recipients were studied, of whom 5306 were from heart-beating donors (HBD) and 1016 from non-heart-beating donors (NHBD). The mean CIT was 24.0 h in the HBD group and 21.6 h in the NHBD group. The rate of delayed graft function (DGF) was 12.3% in the HBD group and 50.4% in the NHBD group. Multivariate analysis showed that prolonged CIT was an independent risk factor for graft failure. Prolonged CIT was also associated with the more frequent occurrence of DGF and primary non-function (PNF). Recipients of renal allografts from HBD with CIT ≤ 20 hours showed a 3% higher 5-year graft survival rate than in recipients of kidneys with longer CIT. In recipients of NHBD kidneys with CIT < 16 hours, the 5-year graft survival rate was 10% higher than in recipients of kidneys with a longer CIT.

Prolonged cold ischaemia times are related to a more frequent occurrence of DGF, PNF and decreased graft survival after kidney transplantation. These results underline the need to reduce cold ischaemia times in the Netherlands.