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Cold pulsatile machine perfusion versus static cold storage for kidneys donated after circulatory death: a multicenter randomized controlled trial.

Research paper by Dominic M DM Summers, Niaz N Ahmad, Lucy V LV Randle, Ann-Marie AM O'Sullivan, Rachel J RJ Johnson, David D Collett, Magdy M Attia, Marc M Clancy, Afshin A Tavakoli, Murat M Akyol, Neville V NV Jamieson, J Andrew JA Bradley, Christopher Je CJ Watson

Indexed on: 18 Aug '20Published on: 14 Aug '19Published in: Transplantation



Abstract

The benefits of cold pulsatile machine perfusion for the storage and transportation of kidneys donated after circulatory-death (DCD) are disputed. We conducted a UK-based multicenter, randomized controlled trial to compare outcomes of kidneys stored with machine perfusion (MP) versus static cold storage (CS). 51 pairs of DCD donor kidneys were randomly allocated to receive static cold storage or cold pulsatile machine perfusion. The primary endpoint, delayed graft function (DGF), was analyzed by 'intention-to-treat' evaluation. There was no difference in the incidence of DGF between CS and MP (32/51 (62.8%) and 30/51 (58.8%) p= 0.69, respectively), although the trial stopped early due to difficulty with recruitment. There was no difference in the incidence of acute rejection, or in graft or patient survival between the CS and MP groups. Median eGFR at 3 months following transplantation was significantly lower in the CS group compared to MP (CS 34 mL/min IQR 26-44 vs MP 45 ml/min IQR 36-60, p = 0.006), although there was no significant difference in eGFR between CS and MP at 12 months post transplant. This study is underpowered, which limits definitive conclusions about the use of machine perfusion, as an alternative to static cold storage. It did not demonstrate that the use of machine perfusion reduces the incidence of delayed graft function in donation after circulatory death kidney transplantation. ISRCTN50082383.

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