Abstract
Hypothermic machine perfusion (HMP) has been introduced as an alternative to static cold storage (SCS) in kidney transplantation, but its true benefit in the clinical routine remains incompletely understood. The aim of this study was to assess the effect of HMP vs. SCS in kidney transplantation. All kidney transplants performed between 08/2015 and 12/2019 (n = 347) were propensity score (PS) matched for cold ischemia time (CIT), extended criteria donor (ECD), gender mismatch, cytomegalovirus (CMV) mismatch, re-transplantation and Eurotransplant (ET) senior program. A total of 103 HMP and 103 SCS instances fitted the matching criteria. Prior to PS matching, the CIT was longer in the HMP group (17.5 h vs. 13.3 h; p < 0.001), while the delayed graft function (DGF) rates were 29.8% and 32.3% in HMP and SCS, respectively. In the PS matched groups, the DGF rate was 64.1% in SCS vs. 31.1% following HMP: equivalent to a 51.5% reduction of the DGF rate (OR 0.485, 95% CI 0.318–0.740). DGF was associated with decreased 1- and 3-year graft survival (100% and 96.3% vs. 90.8% and 86.7%, p = 0.001 and p = 0.008) or a 4.1-fold increased risk of graft failure (HR = 4.108; 95% CI: 1.336–12.631; p = 0.014). HMP significantly reduces DGF in kidney transplantation. DGF remains a strong predictor of graft survival.
Highlights
Kidney transplantation (KTx) is the therapy of choice for patients with end-stage renal disease (ESRD)
The aim of our study was to investigate the impact of Hypothermic machine perfusion (HMP) on kidney graft function after deceased donor kidney transplantation in an HMP cohort propensity score matched with static cold storage (SCS) (PS cohort)
delayed graft function (DGF) occurred in 37/124 patients (29.8%) and 72/223 patients (32.3%) following HMP and SCS (p = 0.638)
Summary
Kidney transplantation (KTx) is the therapy of choice for patients with end-stage renal disease (ESRD). Extended criteria donor (ECD) organs and organs recovered from donation after circulatory death (DCD), are more vulnerable to ischemia reperfusion injury. This eventually translates into higher rates of delayed graft function (DGF), primary non-function (PNF) and inferior graft survival [2,3,4,5]. ECD organs with prolonged travel time are discarded at a high rate, since transplant surgeons and physicians fear the increased risk of DGF and PNF [1]. Considering the benefit of ECD organ use and further decreasing the discard rate, optimal organ preservation and ex situ organ quality assessment remain key tools for eventually increasing utilization in kidney transplantation. The aim of our study was to investigate the impact of HMP on kidney graft function after deceased donor kidney transplantation in an HMP cohort propensity score matched with SCS (PS cohort)
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