The Elimination of Warm Ischemic Time in Kidney Transplantation Using the Ice Bag Technique: A Feasibility Study

Warm ischemic time is an established risk factor for delayed graft function (DGF) after kidney transplantation. DGF is a negative prognostic indicator for long-term allograft survival. We propose a technique that eliminates warm ischemic time during the arterial and venous anastomoses. This is a retrospective review of the first 20 cases performed between January and May 2010 at Albert Einstein Medical Center, Philadelphia, Pennsylvania, a nonuniversity tertiary care center. Approximately one-half of the patients who underwent kidney transplantation were selected for this method of implantation while the feasibility of this technique was evaluated. Fifteen patients were male. DGF was seen in 6 of 20 patients (30%). There were no graft losses. Operative time was not lengthened. There were no complications related to the use of this technique. Renal parenchyma frostbite was never encountered. We propose a technique that eliminates warm ischemic time. This may lead to less DGF. In the case of a difficult anastomosis or if an anastomosis needs to be performed again, damage to the kidney is minimized. Right and left donor kidneys and kidneys with multiple vessels can safely be transplanted with this technique. It also allows for improved resident and fellow teaching.