{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T03:16:06Z","timestamp":1791861366264,"version":"4.3.4"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["1R01DK118425-01A1"],"award-info":[{"award-number":["1R01DK118425-01A1"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Reducing discard is important for the US transplantation system because nearly 20% of the deceased donor kidneys are discarded. One cause for the discards is the avoidance of protracted cold ischemia times. Extended cold ischemia times at transplant are associated with additional risk of graft failure and patient mortality. A preference for local (within the same donor service area) or low\u2013Kidney Donor Risk Index organs, the endogeneity of cold ischemia time during organ allocation, and the use of provisional offers all complicate the analysis of cold ischemia times\u2019 influence on kidney acceptance decision making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, &amp; measurements<\/jats:title>\n                    <jats:p>Using January 2018 to June 2019 Organ Procurement and Transplantation Network data, we modeled the probability of accepting an offer for a kidney after provisional acceptance. We use logistic regression that includes cold ischemia time, Kidney Donor Risk Index, and other covariates selected from literature. Endogeneity of cold ischemia time was treated by a two-stage instrumental variables approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Logistic regression results for 3.33 million provisional acceptances from 12,369 donors and 108,313 candidates quantify trade-offs between cold ischemia time at the time of offer acceptance and donor-recipient characteristics. Overall, each additional 2 hours of cold ischemia time affected acceptance for nonlocal and local recipients (odds ratio, 0.75; 95% confidence interval, 0.73 to 0.77, odds ratio, 0.88; 95% confidence interval, 0.86 to 0.91;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). For Kidney Donor Risk Index &gt;1.75 (Kidney Donor Profile Index &gt;85) kidneys, an additional 2 hours of cold ischemia time for nonlocal and local recipients was associated with acceptance with odds ratio, 0.58; 95% confidence interval, 0.54 to 0.63 (nonlocal) and odds ratio, 0.65; 95% confidence interval, 0.6 to 0.7 (local);\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001. The effect of an additional 2 hours of cold ischemia time on acceptance of kidneys with Kidney Donor Risk Index \u22641.75 (Kidney Donor Profile Index \u226485) was less pronounced for nonlocal offers (odds ratio, 0.82; 95% confidence interval, 0.80 to 0.85;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) and not significant for local offers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The acceptability of marginal organs was higher when placements were nearer to the donor and when cold ischemia time was shorter.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.01600222","type":"journal-article","created":{"date-parts":[[2022,7,22]],"date-time":"2022-07-22T13:15:13Z","timestamp":1658495713000},"page":"1353-1362","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":27,"title":["Implications of Accumulated Cold Time for US Kidney Transplantation Offer Acceptance"],"prefix":"10.2215","volume":"17","author":[{"given":"Masoud","family":"Barah","sequence":"first","affiliation":[{"name":"Department of Industrial Engineering and Management Sciences, Northwestern University, Evanston, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1730-2163","authenticated-orcid":false,"given":"Vikram","family":"Kilambi","sequence":"additional","affiliation":[{"name":"Department of Engineering and Applied Sciences, RAND Corporation, Arlington, Virginia"},{"name":"RAND Health Care, Access and Delivery Program, RAND Corporation, Arlington, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J.","family":"Friedewald","sequence":"additional","affiliation":[{"name":"Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois"},{"name":"Division of Nephrology, Department of Medicine, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1106-1901","authenticated-orcid":false,"given":"Sanjay","family":"Mehrotra","sequence":"additional","affiliation":[{"name":"Department of Industrial Engineering and Management Sciences, Northwestern University, Evanston, Illinois"},{"name":"Center for Engineering and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois"},{"name":"Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Northwestern 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