{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T14:02:21Z","timestamp":1792677741978,"version":"4.5.0"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontierspartnerships.org"],"crossmark-restriction":true},"short-container-title":["Transpl. Int."],"abstract":"<jats:p>With the age of those awaiting kidney transplantation (KTx) increasing, the Eurotransplant Senior Program (ESP) reduces median waiting time by &amp;gt; 1.5\u00a0years for patients aged \u226565 compared to standard allocation and doubles life expectancy compared with remaining on dialysis. However, older-donor organs are more vulnerable to prolonged cold ischemia time (CIT). To minimize CIT, both kidneys from one donor are regionally allocated, in our case, to a single transplant center. This study assesses the impact of CIT on delayed graft function (DGF) and long-term outcomes in consecutively transplanted ESP recipients from the same donor. We retrospectively analyzed 208 ESP KTx at Freiburg Transplant Center (1999\u20132019), focusing on 74 consecutively transplanted kidney pairs (recipients ranked \u201c1\u201d or \u201c2\u201d). DGF incidence was similar for rank 1 and rank 2 recipients. CIT &amp;gt;12\u00a0h significantly increased DGF risk versus CIT &amp;lt;8\u00a0h (adjusted OR 6.30; 95% CI 1.52\u201326.06; p = 0.011). Death-censored allograft survival was unaffected, but CIT &amp;gt;12\u00a0h tripled mortality risk (adjusted HR 3.19; 95% CI 1.44\u20137.49; p = 0.005). Consecutive transplantation does not disadvantage the second recipient if CIT remains &amp;lt;12\u00a0h. CIT &amp;gt;12\u00a0h independently predicts DGF and higher mortality, emphasizing the need to minimize ischemia time.<\/jats:p>","DOI":"10.3389\/ti.2026.15840","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T05:10:09Z","timestamp":1781673009000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Cold ischemia time exceeding 12 hours is a risk factor for delayed graft function and increased mortality in kidney transplant recipients within the eurotransplant senior program"],"prefix":"10.3389","volume":"39","author":[{"given":"Laura","family":"Matuschik","sequence":"first","affiliation":[{"name":"Department of General and Visceral Surgery, Section of Transplant Surgery, Faculty of Medicine, Medical Center - University of Freiburg","place":["Freiburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Andr\u00e9","sequence":"additional","affiliation":[{"name":"Department of General and Visceral Surgery, Section of Transplant Surgery, Faculty of Medicine, Medical Center - University of Freiburg","place":["Freiburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp A.","family":"Holzner","sequence":"additional","affiliation":[{"name":"Department of General and Visceral Surgery, Section of Transplant Surgery, Faculty of Medicine, Medical Center - University of Freiburg","place":["Freiburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dietrich A.","family":"Ruess","sequence":"additional","affiliation":[{"name":"Department of General and Visceral Surgery, Section of Transplant Surgery, Faculty of Medicine, Medical Center - University of Freiburg","place":["Freiburg, Germany"]},{"name":"German Cancer Consortium (DKTK), Partner Site Freiburg and German Cancer Research Center (DKFZ)","place":["Heidelberg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yakup","family":"Tanriver","sequence":"additional","affiliation":[{"name":"Department of Medicine IV \u2013 Nephrology and Primary Care, Faculty of Medicine, Medical Center - University of Freiburg","place":["Freiburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Schneider","sequence":"additional","affiliation":[{"name":"Department of Medicine IV \u2013 Nephrology and Primary Care, Faculty of Medicine, Medical Center - University of Freiburg","place":["Freiburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"J\u00e4nigen","sequence":"additional","affiliation":[{"name":"Department of General and Visceral Surgery, Section of Transplant Surgery, Faculty of Medicine, Medical Center - University of Freiburg","place":["Freiburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1093\/ndt\/gfh506","article-title":"Expanding the donor pool to increase renal transplantation","volume":"20","author":"Cohen","year":"2005","journal-title":"Nephrol Dial Transpl"},{"key":"B2","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1111\/j.1432-2277.2008.00777.x","article-title":"An old virtue to improve senior programs","volume":"22","author":"de Fijter","year":"2009","journal-title":"Transpl Int"},{"key":"B3","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1097\/00007890-200007270-00015","article-title":"Permanent detrimental effect of nonimmunological factors on long-term renal graft survival: a parsimonious model of time-dependency","volume":"70","author":"Smits","year":"2000","journal-title":"Transplantation"},{"key":"B4","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1111\/j.1600-6143.2007.02014.x","article-title":"Prospective age-matching in elderly kidney transplant recipients--a 5-year analysis of the eurotransplant senior program","volume":"8","author":"Frei","year":"2008","journal-title":"Am J Transpl"},{"key":"B5","doi-asserted-by":"publisher","first-page":"559","DOI":"10.3238\/arztebl.m2024.0137","article-title":"Allocation rules and age-dependent waiting times for kidney transplantation","volume":"121","author":"Kolbrink","year":"2024","journal-title":"Dtsch Arztebl Int"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1859","DOI":"10.1681\/ASN.2004121092","article-title":"Impact of cadaveric renal transplantation on survival in patients listed for transplantation","volume":"16","author":"Oniscu","year":"2005","journal-title":"J Am Soc Nephrol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1725","DOI":"10.1056\/NEJM199912023412303","article-title":"Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant","volume":"341","author":"Wolfe","year":"1999","journal-title":"N Engl J Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1681\/ASN.V123589","article-title":"Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates","volume":"12","author":"Ojo","year":"2001","journal-title":"J Am Soc Nephrol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1551","DOI":"10.1016\/j.ajt.2023.07.006","article-title":"Survival after kidney transplantation compared with ongoing dialysis for people over 70 years of age: a matched-pair analysis","volume":"23","author":"Shi","year":"2023","journal-title":"Am J Transpl"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1434","DOI":"10.1046\/j.1600-6135.2003.00251.x","article-title":"Old-for-old kidney allocation allows successful expansion of the donor and recipient pool","volume":"3","author":"Fritsche","year":"2003","journal-title":"Am J Transpl"},{"key":"B11","doi-asserted-by":"publisher","first-page":"201","DOI":"10.12659\/AOT.890125","article-title":"Prognostic factors for kidney allograft survival in the eurotransplant senior program","volume":"19","author":"Bahde","year":"2014","journal-title":"Ann Transpl"},{"key":"B12","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1111\/j.1399-0012.2006.00508.x","article-title":"The advantage of allocating kidneys from old cadaveric donors to old recipients: a single-center experience","volume":"20","author":"Bodingbauer","year":"2006","journal-title":"Clin Transpl"},{"key":"B13","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1097\/01.tp.0000168340.05714.99","article-title":"Long-term patient and graft survival in the eurotransplant senior program: a single-center experience","volume":"80","author":"Fabrizii","year":"2005","journal-title":"Transplantation"},{"key":"B14","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1006\/jsre.2000.5921","article-title":"The effect of age and prolonged cold ischemia times on the national allocation of cadaveric renal allografts","volume":"91","author":"Lee","year":"2000","journal-title":"J Surg Res"},{"key":"B15","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1007\/s00147-002-0439-4","article-title":"Early experience with the ET senior program \u201cold for old\u201d; better to be number one?","volume":"15","author":"Kruger","year":"2002","journal-title":"Transpl Int"},{"key":"B16","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1111\/j.1523-1755.2004.761_11.x","article-title":"Long-term effects of acute ischemia and reperfusion injury","volume":"66","author":"Gueler","year":"2004","journal-title":"Kidney Int"},{"key":"B17","doi-asserted-by":"publisher","first-page":"930","DOI":"10.1093\/ndt\/14.4.930","article-title":"Donor age and delayed graft function as predictors of renal allograft survival in rejection-free patients","volume":"14","author":"Moreso","year":"1999","journal-title":"Nephrol Dial Transpl"},{"key":"B18","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1002\/ar.1092320205","article-title":"Glomerular number and size in relation to age, kidney weight, and body surface in normal man","volume":"232","author":"Nyengaard","year":"1992","journal-title":"Anat Rec"},{"key":"B19","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1034\/j.1399-0012.2000.140302.x","article-title":"A tale of two kidneys--how long can a kidney transplant wait?","volume":"14","author":"Tandon","year":"2000","journal-title":"Clin Transpl"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1689","DOI":"10.1093\/ndt\/gfl042","article-title":"Major effects of delayed graft function and cold ischaemia time on renal allograft survival","volume":"21","author":"Quiroga","year":"2006","journal-title":"Nephrol Dial Transpl"},{"key":"B21","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1007\/s001470050295","article-title":"Long-term results of 1047 cadaveric kidney transplantations with special emphasis on initial graft function and rejection","volume":"13","author":"Kyllonen","year":"2000","journal-title":"Transpl Int"},{"key":"B22","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1007\/s00423-019-01812-y","article-title":"Single cohort study: ABO-Incompatible kidney transplant recipients have a higher risk of lymphocele formation","volume":"404","author":"Janigen","year":"2019","journal-title":"Langenbecks Arch Surg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"2461","DOI":"10.1097\/TP.0000000000003629","article-title":"Influence of cold ischemia time on the outcome of kidney transplants from donors aged 70 years and Above-A collaborative transplant study report","volume":"105","author":"Echterdiek","year":"2021","journal-title":"Transplantation"},{"key":"B24","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1097\/01.tp.0000251781.36117.27","article-title":"Multicenter analysis of kidney preservation","volume":"83","author":"Opelz","year":"2007","journal-title":"Transplantation"},{"key":"B25","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1016\/j.kint.2023.05.025","article-title":"A paired-kidney allocation study found superior survival with HLA-DR compatible kidney transplants in the eurotransplant senior program","volume":"104","author":"de Fijter","year":"2023","journal-title":"Kidney Int"},{"key":"B26","doi-asserted-by":"publisher","first-page":"4055","DOI":"10.1093\/ndt\/gfq338","article-title":"Comparison of first and second kidney transplants from the same deceased donor","volume":"25","author":"Giessing","year":"2010","journal-title":"Nephrol Dial Transpl"},{"key":"B27","doi-asserted-by":"publisher","first-page":"94","DOI":"10.12659\/aot.895731","article-title":"Deceased donor Kidney transplantation in the eurotransplant senior program (ESP): a single-center experience from 2008 to 2013","volume":"21","author":"Jacobi","year":"2016","journal-title":"Ann Transpl"},{"key":"B28","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1097\/00007890-199704150-00011","article-title":"Delayed graft function: risk factors and implications for renal allograft survival","volume":"63","author":"Ojo","year":"1997","journal-title":"Transplantation"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1097\/TP.0b013e31819cdddd","article-title":"Clinical outcomes in elderly kidney transplant recipients are related to acute rejection episodes rather than pretransplant comorbidity","volume":"87","author":"Heldal","year":"2009","journal-title":"Transplantation"},{"key":"B30","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/j.eururo.2021.12.008","article-title":"Kidney transplantation outcome predictions (KTOP): a risk prediction tool for kidney transplants from brain-dead deceased donors based on a large European cohort","volume":"83","author":"Miller","year":"2023","journal-title":"Eur Urol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1111\/j.1600-6143.2005.00798.x","article-title":"A comparison of long-term graft survival rates between the first and second donor kidney transplanted--the effect of a longer cold ischaemic time for the second kidney","volume":"5","author":"Giblin","year":"2005","journal-title":"Am J Transpl"},{"key":"B32","doi-asserted-by":"publisher","first-page":"2043","DOI":"10.1093\/ndt\/gfm912","article-title":"Renal transplantation in the elderly: surgical complications and outcome with special emphasis on the eurotransplant senior programme","volume":"23","author":"Bentas","year":"2008","journal-title":"Nephrol Dial Transpl"},{"key":"B33","doi-asserted-by":"publisher","first-page":"2143","DOI":"10.1093\/ndt\/gfw248","article-title":"Immunologic outcome in elderly kidney transplant recipients: is it time for HLA-DR matching?","volume":"31","author":"Halleck","year":"2016","journal-title":"Nephrol Dial Transpl"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1207","DOI":"10.1097\/01.tp.0000261108.27421.bc","article-title":"Simpler and equitable allocation of kidneys from postmortem donors primarily based on full HLA-DR compatibility","volume":"83","author":"Doxiadis","year":"2007","journal-title":"Transplantation"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.1097\/00007890-200211270-00005","article-title":"Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: a paired donor kidney analysis","volume":"74","author":"Meier-Kriesche","year":"2002","journal-title":"Transplantation"},{"key":"B36","doi-asserted-by":"publisher","first-page":"S13","DOI":"10.1016\/S1166-7087(14)70058-2","article-title":"Innate and adaptive immune responses subsequent to ischemia-reperfusion injury in the kidney","volume":"24","author":"Denecke","year":"2014","journal-title":"Prog Urol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1344","DOI":"10.1097\/TP.0000000000002188","article-title":"The benefits of hypothermic machine preservation and short cold ischemia times in deceased donor kidneys","volume":"102","author":"Kox","year":"2018","journal-title":"Transplantation"},{"key":"B38","doi-asserted-by":"publisher","first-page":"e13536","DOI":"10.1111\/ctr.13536","article-title":"Evaluation of outcomes in renal transplantation with hypothermic machine perfusion for the preservation of kidneys from expanded criteria donors","volume":"33","author":"Savoye","year":"2019","journal-title":"Clin Transpl"},{"key":"B39","doi-asserted-by":"publisher","first-page":"2311","DOI":"10.3390\/jcm9072311","article-title":"A retrospective propensity score matched analysis reveals superiority of hypothermic machine perfusion over static cold storage in deceased donor kidney transplantation","volume":"9","author":"Gasteiger","year":"2020","journal-title":"J Clin Med"},{"key":"B40","doi-asserted-by":"publisher","first-page":"4458","DOI":"10.1093\/ndt\/gfs321","article-title":"Machine perfusion versus cold storage for the preservation of kidneys from donors >\/= 65 years allocated in the eurotransplant senior programme","volume":"27","author":"Gallinat","year":"2012","journal-title":"Nephrol Dial Transpl"},{"key":"B41","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1002\/bjs.7481","article-title":"Hypothermic machine perfusion after static cold storage does not improve the preservation condition in an experimental porcine kidney model","volume":"98","author":"Hosgood","year":"2011","journal-title":"Br J Surg"},{"key":"B42","doi-asserted-by":"publisher","first-page":"S110","DOI":"10.1016\/S1743-9191(13)60029-1","article-title":"Impact of static cold storage VS hypothermic machine preservation on ischemic kidney graft: inflammatory cytokines and adhesion molecules as markers of ischemia\/reperfusion tissue damage. Our preliminary results","volume":"11","author":"Tozzi","year":"2013","journal-title":"Int J Surg"}],"container-title":["Transplant International"],"original-title":[],"link":[{"URL":"https:\/\/www.frontierspartnerships.org\/articles\/10.3389\/ti.2026.15840\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T05:10:11Z","timestamp":1781673011000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontierspartnerships.org\/articles\/10.3389\/ti.2026.15840\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,17]]},"references-count":42,"alternative-id":["10.3389\/ti.2026.15840"],"URL":"https:\/\/doi.org\/10.3389\/ti.2026.15840","relation":{},"ISSN":["1432-2277"],"issn-type":[{"value":"1432-2277","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,17]]},"article-number":"15840"}}