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The benefits of hypothermic machine preservation and short cold ischemia times in deceased donor kidneys.

Research paper by Jjhfm J Kox, C C Moers, D D Monbaliu, A A Strelniece, J J Treckmann, I I Jochmans, Hgd H Leuvenink, Lwe L Van Heurn, J J Pirenne, A A Paul, R J RJ Ploeg

Indexed on: 24 Mar '18Published on: 24 Mar '18Published in: Transplantation



Abstract

Hypothermic machine perfusion (HMP) of deceased donor kidneys is associated with better outcome when compared to static cold storage (CS). Nevertheless, there is little evidence whether kidneys with short cold ischemia time (CIT) also benefit from HMP and whether HMP can safely extend CIT. We analysed prospectively collected data from the Machine Preservation Trial, an international randomized controlled trial. 752 Consecutive renal transplants were included: 1 kidney of each of the 376 donors was preserved by HMP, the contralateral organ was preserved by CS. The mean CIT was 15:05 hours (SD 4:58 hours). A subgroup analysis was performed, groups were based on CIT duration: 0-10 hours, 10-15 hours, 15-20 hours, or 20 hours and more. Delayed graft function (DGF) incidence in the subgroup with up to 10 hours CIT was 6.0% (N=3/50) in the HMP arm and 28.1% (N=18/64) in the CS arm (univariable p=0.002, multivariable OR 0.02, p=0.007). CIT remained an independent risk factor for DGF for machine perfused kidneys recovered from DBD donors OR 1.06, 95% CI 1.017-1.117, p=0.008), DCD donors (OR 1.13, 95% CI 1.035-1.233, p=0.006) and ECD donors (OR 1.14, 95% CI 1.057-1.236, p=0.001). In conclusion, HMP resulted in remarkably lower rates of DGF in renal grafts that were transplanted after a short CIT. Also, CIT remained an independent risk factor for DGF in HMP-preserved kidneys.