Abstract

Objective In order to discuss and summarize the indications of hypothermic machine perfusion (HMP), to observe and analyze the clinical effects of HMP in preservation of standard criteria donors (SCD) and extended criteria donors (ECD). Methods This study retrospectively analyzed 165 pairs of donated kidneys (255 kidney transplantation cases) in the 303rd Hospital of Chinese People's Liberation Army from June 2007 to December 2014. The kidneys were divided into two groups according to different types of donated kidneys: SCD (134 cases) and ECD (121 cases). The ECD group was divided into ECD1 subgroup (74 cases) and ECD2 subgroup (47 cases) according to the causes and degrees of kidney injury. We also divided SCD and ECD into 4 subgroups according to different types of preservation methods: SCD-cold storage (CS) (112 cases), SCD-HMP (22 cases), ECD-CS (63 cases) and ECD-HMP (58 cases). Then we analyzed the effects of HMP on the recovery of renal function and complications after renal transplantation. Results HMP promoted the recovery of early graft in SCD group and ECD1 subgroup, mainly reflected in advancing peak in dieresis stage and faster reduction of creatinine, but there were no significant differences in the AR and DGF rate, the creatinine at discharge, 1-year survival rate of grafts and recipients between HMP and CS (P>0.05). HMP increased the cold ischemia time and the cost of preservation. By HMP in ECD2 subgroup, we observed a lower DGF rate, shorter DGF lasting time and lower creatinine level at discharge than by CS. HMP increased the cost of preservation but decreased the expense in hospital by promoting the recovery of renal function and shortening the hospital stay. There was no significant difference in 1-year survival rate of grafts and recipients after renal transplantation between HMP and CS (P>0.05). Conclusion HMP promoted the recovery of grafts in the early days to some extent but increased the cost of preservation in SCD group and ECD1 subgroup, suggesting HMP has no significant preservation advantage. ECD2 by HMP receive better clinical and economical benefits, and are the indication of using HMP. Key words: Kidney transplantation; SCD; ECD; Machine perfusion; Cold storage

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