Cold Pulsatile Machine Perfusion versus Static Cold Storage in Kidney Transplantation: A Single Centre Experience.

Maria Irene Bellini,Vassilios Papalois,Jeremy Crane,Anand Muthusamy,Paul Elliot Herbert,Vasileios Bonatsos,Frank J M F Dor,Sotiris Charalampidis

doi:10.1155/2019/7435248

Maria Irene Bellini, Vassilios Papalois + Show 6 more

Open Access

https://doi.org/10.1155/2019/7435248

Copy DOI

Abstract

Introduction We present our experience with hypothermic machine perfusion (HMP) versus cold storage (CS) in relation to kidney transplant outcomes. Methods Retrospective analysis of 33 consecutive HMP kidney transplant outcomes matched with those of 33 cold stored: delayed graft function (DGF), length of hospital stay (LOS), estimated glomerular filtration rate (eGFR), and patient and graft survival were compared. Renal Resistive Indexes (RIs) during HMP in relation to DGF were also analysed. Results In the HMP group, mean HMP time was 5.7 ± 3.9 hours with a mean cold ischaemic time (CIT) of 15 ± 5.6 versus 15.1 ± 5.3 hours in the CS group. DGF was lower in the HMP group (p=0.041), and donation after Circulatory Death (DCD) was a predictor for DGF (p<0.01). HMP decreased DGF in DCD grafts (p=0.036). Patient and graft survival were similar, but eGFR at 365 days was higher in the HMP cohort (p<0.001). RIs decreased during HMP (p<0.01); 2-hours RI ≥ 0.45 mmHg/mL/min predicted DGF in DCD kidneys (75% sensitivity, 80% specificity; area under the curve 0.78); 2-hours RI ≥ 0.2 mmHg/ml/min predicted DGF in DBD grafts (sensitivity 100%, specificity 91%; area under the curve 0.87). Conclusion HMP decreased DGF compared to CS, offering viability assessment pretransplant and improving one-year renal function of the grafts.

Highlights

We present our experience with hypothermic machine perfusion (HMP) versus cold storage (CS) in relation to kidney transplant outcomes
The increasing demand for renal allografts and growing waiting lists has led to the utilization of organs through donation after Circulatory Death (DCD), these organs are associated with higher rates of discard, retrieval associated injury [1], and up to 50% delayed graft function (DGF) in comparison to transplanted organs from donors after Brainsteam Death (DBD) [2]
No statistical difference was observed between the HMP and CS group baseline characteristics: mean recipient’s age, cause of kidney failure, numbers of grafts from DCD and DBD donors, number of Human Leukocyte Antigen (HLA) mismatches between donor and recipient, donor’s age and cold ischaemic time (CIT)

Summary

Introduction

We present our experience with hypothermic machine perfusion (HMP) versus cold storage (CS) in relation to kidney transplant outcomes. Animal studies have demonstrated that one of the main benefits of using cold pulsatile perfusion for preservation, is attributed to the improved endothelial release of nitric oxide and reduced secretion of endothelin-1 [9], resulting in a renoprotective effect [10], not achievable with standard static cold storage. This effect in the renal microvasculature provides a unique platform for active organ reconditioning during HMP, expressed in significantly lower number of pathological lesions on kidney biopsies [10]

Objectives

Methods

Results

Discussion

Conclusion