Approaches to Mitigate Longer Cold Ischemic Times and Increased Rates of Delayed Graft Function Associated With the Revised Kidney Allocation System

Purpose of Review A new geographic distance-based allocation system was unveiled across the USA in 2021 to increase the efficiency and equity of kidney transplant allocations. Modeled after a similar change to the allocation system for lung transplants in 2017, the Organ Procurement and Transplantation Network utilized rigorous methods and statistical modeling to devise a system that would not only increase transplant rates but also improve access for marginalized groups. Recent Findings Now, approximately 2 years post-implementation, the new allocation system has proven to significantly increase access to transplantation for numerous recipient groups; however, these changes were associated with increasing rates of delayed graft function (DGF) and longer cold ischemic times (CIT). In this review, we discuss multiple methods to help mitigate the effects of longer cold ischemic times and delayed graft function. Optimizing the medical management of donors, improving modifiable recipient risk factors, utilizing machine perfusion, and improving organ allocation policies are just some of the methods discussed to decrease CIT and DGF. Summary There are promising new technologies that may be utilized in the future to help further curb the effects of CIT on DGF. Regardless, renal transplantation remains the gold standard treatment for ESRD and must still be pursued when suitable donors and recipients are identified.