2318 THE BENEFITS OF MACHINE PERFUSION OF STANDARD-CRITERIA DECEASED DONOR KIDNEYS AT A GEOGRAPHICALLY REMOTE TRANSPLANT CENTER

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation, Renal Vascular Surgery (II)1 Apr 20132318 THE BENEFITS OF MACHINE PERFUSION OF STANDARD-CRITERIA DECEASED DONOR KIDNEYS AT A GEOGRAPHICALLY REMOTE TRANSPLANT CENTER Shih-Chieh Jeff Chueh, Bashir R. Sankari, Lorie Lipscomb, Asmita Modack, and Michael G. Castello Shih-Chieh Jeff ChuehShih-Chieh Jeff Chueh Cleveland, OH More articles by this author , Bashir R. SankariBashir R. Sankari Cleveland, OH More articles by this author , Lorie LipscombLorie Lipscomb Charleston, WV More articles by this author , Asmita ModackAsmita Modack Charleston, WV More articles by this author , and Michael G. CastelloMichael G. Castello Charleston, WV More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2259AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Machine perfusion (MP) of marginal kidneys has been accepted as ‘standard of practice' in many Organ Procurement Organizations (OPOs) and transplant centers; whereas the benefits of MP standard-criteria donor (SCD) kidneys still remain controversial. Our hospital is located at 4.5-hour drive from our OPO, usually leading to a longer ischemic time. We evaluated the outcomes of MP SCD kidneys under such unique circumstances. METHODS Review Board approved retrospective study of case-matched kidneys transplanted with versus (vs.) without MP (28 vs. 77 recipients) was done to assess the incidence of delayed graft function (DGF) as the primary end-point. Secondary end-points are slow graft function (SGF; defined as though no dialysis needed after transplant but serum creatinine [sCr]> 3 mg/dL on post-operative day 5), primary non-function (PNF), the recovery curve of sCr level and estimated glomerular filtration rate (eGFR, mL/min), acute rejection, the length of hospital stay (LOS), and allograft and patient survival. RESULTS Those recipients who received MP SCD kidneys (group 1) had significantly lower DGF incidence (3.6% vs. 23.4%, P= .02) than those who received cold-storage (CS) SCD kidneys (group 2). Group 1 recipients also had lower SGF rate (7.1% vs. 24.7%; P= .04). The sCr recovery curve is significantly faster in group 1 (Figure 1, P< .001). None of the MP recipients, while 16.9% of group 2 patients, experienced oliguria. Recipients in group 1 had shorter follow-up than those in group 2. There was no difference among PNF rate, incidence of acute rejection, LOS, and graft or patient survivals between these 2 groups. In a multivariate logistic regression, MP kidneys are significantly less likely (odds ratio [OR] .06) to cause either DGF, SGF or PNF. With a Cox-proportional hazards model to test the effect of MP on graft function recovery, group 1 recipients are more likely to recover quicker to either eGFR > 30 (OR 3.4, P < .001), or eGFR > 60 (OR 2.5, P= .01). CONCLUSIONS This retrospective review favorably proved our hypothesis that machine perfusion significantly decrease the incidences of DGF and SGF of SCD kidneys in a geographically remote transplant center. Prospective study is required to further confirm this finding. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e950-e951 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shih-Chieh Jeff Chueh Cleveland, OH More articles by this author Bashir R. Sankari Cleveland, OH More articles by this author Lorie Lipscomb Charleston, WV More articles by this author Asmita Modack Charleston, WV More articles by this author Michael G. Castello Charleston, WV More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...