“Time is tissue”—A minireview on the importance of donor nephrectomy, donor hepatectomy, and implantation times in kidney and liver transplantation

Abstract

Donor organs are exposed to sequential temperature changes during the transplantation process. The role of donor warm ischemia and cold ischemia times on post-transplant outcomes has been extensively studied. Much less attention has been paid to the transient ischemia occurring during donor organ removal and implantation. Recently, it has become clear that prolonged donor nephrectomy and implantation time are independently associated with delayed graft function after kidney transplantation. In addition, implantation time correlates with post-transplant kidney graft function, histology, and survival. Similar detrimental associations of donor hepatectomy and implantation time with early allograft dysfunction, ischemic cholangiopathy, and graft and patient survival after liver transplantation have been demonstrated. This review details kidney and liver temperature changes occurring during procurement and transplantation. It summarizes the effects of the ischemia the kidney and liver sustain during these phases on short- and long-term post-transplant outcomes, advocating the standardized reporting of donor hepatectomy, donor nephrectomy, and implantation times in (inter)national registries. The review also explores strategies to protect the graft from this ischemic injury.