Background: In the Netherlands, 50% of deceased donor kidney offers are after circulatory death (DCD). Several criteria such as cold ischemia time and warm ischemia time are known to impact delayed graft function (DGF) rates and allograft survival. Extraction time of organs during multivisceral procurements is a relatively new ischemia time. This time begins with aortic cross-clamp and perfusion/cooling of the kidneys, and ending with removal of the kidneys and placement on ice on the back table. During this period cooling of the kidneys are suboptimal with ongoing ischemia. However, evidence is lacking whether extraction time has a negative effect on the primary kidney function.
Methods: Between 2014 and 2016, 575 DCD kidneys were procured and transplanted in the Netherlands. Donor and recipient characteristics with intraoperative procurement information and transplant outcomes were obtained from the database of the Dutch Transplant Foundation (NTS). Primary outcome parameters were the incidence of Delayed Graft Function (DGF) and graft survival. Linear regression analysis with receiver operating characteristic (ROC) curves was performed to evaluate associations between extraction times and primary outcomes parameters.
Results:  Extraction time ranged from 14 to 198 min, with a mean of 61.7min. In 191 procedures only kidneys were retrieved with significantly shorter extraction times (43 min vs. 71 min) (r = 0.187, p < 0.001). Occurrence of DGF between kidney only and multi organ procurements was not significant (43.2% vs. 46.6%) (p = 0.497). Extraction time was not associated with DGF (r = 0.536, p = 0.183), graft survival (r = 0.541, p = 0.363) and Primary Non Function (r = 0.608, p = 0.292).
Conclusion: Extraction time did not influence initial kidney function and graft survival.  Shorter extraction times in kidney only procurements did not lower DGF percentages compared to multi organ procurements.