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Cryopreserved venous allografts increased cold ischemia time in living-donor kidney transplant recipientsDoes stretching a kidney vein during transplant add dangerous wait time for the organ?

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Key Takeaway
Note increased cold ischemia time with cryopreserved venous allografts in this preliminary cohort of nine cases.

This study evaluated the use of cryopreserved venous allografts for renal vein lengthening in living-donor kidney transplant recipients and donors. The research was conducted at two regional university hospitals and included a sample size of nine cases. The intervention involved cryopreserved venous allografts used for vascular extension, which were compared against grafts that did not require elongation. This was a cohort study, and the phase of the research was not reported.

The primary outcome measured was cold ischemia time. Grafts requiring vascular extension demonstrated a higher median cold ischemia time of 139 minutes, with an interquartile range of 130 to 141 minutes. In contrast, grafts without elongation had a median cold ischemia time of 115 minutes, with an interquartile range of 107 to 121 minutes. The specific p-value was not reported.

Safety and tolerability data were not reported, as adverse events, serious adverse events, discontinuations, and overall tolerability were not documented in the study. The follow-up duration was not reported. Key limitations include the preliminary nature of the experience and the fact that the study was conducted at a single institution. Funding sources and conflicts of interest were not reported. Due to these constraints, the certainty of the findings is low, and the results should be interpreted with caution regarding broader clinical application.

Imagine waiting for a vital organ to arrive. Every minute counts when a kidney is outside the body. In this small study, surgeons used cryopreserved venous allografts to lengthen the vein connecting a donor kidney to a recipient. This technique is sometimes necessary when the vessels do not match perfectly. However, the results show a clear trade-off: these extended grafts kept the kidney in cold storage longer than standard grafts.

The data shows a median wait time of 139 minutes for the extended grafts compared to 115 minutes for standard ones. While the study did not report safety issues like organ failure or rejection, the longer wait time is a concern. Cold ischemia time is the period the organ spends without blood flow, which can stress the tissue. We must ask if this extra hour of waiting is worth the technical fix.

This research comes from only nine patients at two regional university hospitals. The authors call this preliminary experience, meaning it is very early in the learning process. Because the sample is so small, we cannot draw broad conclusions about safety or long-term success. Until more data is collected, doctors must weigh the benefit of fixing a vessel mismatch against the risk of a longer wait for the kidney.

What this means for you:
Using frozen vein extensions increases kidney wait time, but safety is unknown due to very few patients.

Study Details

Study typeCohort
EvidenceLevel 3
PublishedApr 2026
View Original Abstract ↓
IntroductionLiving-donor kidney transplantation (LDKT) is the gold standard for end-stage renal disease. Traditionally, the left kidney is preferred for its longer vein. However, the “donor safety first” principle, combined with the transition to laparoscopic and robotic donor nephrectomy, has increased the frequency of using right-sided grafts or encountering “iatrogenically” shortened veins due to mechanical stapling. In this study, we report our preliminary experience evaluating the efficacy of cryopreserved vascular grafts for renal vein lengthening in LDKT to overcome anatomical vascular length limitations.MethodsAll LDKT in this series were performed using a robotic-assisted laparoscopic approach. All procedures were carried out by a dedicated and experienced surgical team thanks to a cross-institutional partnership involving two regional University Hospitals. When necessary, cryopreserved venous allografts were employed to ensure adequate renal vein length. All transplants were carried out using a standard retroperitoneal approach in the iliac fossa.ResultsFrom June 2024 to October 2025, nine living-donor kidney transplants were performed. The donor cohort included 7 females and 2 males with a median age of 58 years (IQR 51–69), while the recipient cohort included 4 females and 5 males with a median age of 39 years (IQR 23–55). Cryopreserved venous allografts were used in 5/9 LDKT (55.5%), following right kidney procurement. Cold ischemia time was higher in grafts requiring vascular extension than in those without elongation (median 139 min [IQR 130–141] vs. 115 min [IQR 107–121], respectively; p 
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