Comparison of IGL-1 Versus UW Ex Vivo Back Table Flush on Early Graft Function after Living Donor Kidney Transplantation

Abstract

Background The Institut Georges Lopez (IGL-1) preservation solution contains the same buffer, osmotic agents and substances protective against ischemia reperfusion injuries as the University of Wisconsin solution. In contrast to UW solution, in the IGL-1 solution the oncotic agent is replaced through PEG 35 (1g/L) and a different intra/extracellular ionic composition is obtained. The aim of this study was to compare the effect of IGL-1 on early kidney graft function compared to UW solution in our living donor kidney transplantation (LDKT) program. Methods Between January 1, 2014 and August 30, 2017, 95 LDKT were performed at our center. Among them, 62 were flushed with UW (UW group) and 33 with IGL-1 (IGL group) preservation solution before transplantation. Donor and recipient characteristics were compared. Primary endpoints were 1) incidence of delayed graft function and time to reach an estimated glomerular filtration rate (eGFR) >40 ml/min/1.73m2. Secondary endpoints were 1) clinical biopsy proven acute rejection (BPAR) incidence and 2) 6 months and 1 year patient- and graft survival. Results The donor and recipient characteristics were comparable between the UW and the IGL group. No primary non-function or delayed graft function were observed in both study groups. Time to reach eGFR>40 ml/min/1.73m2 after transplantation was comparable in both study groups (p=0.107). Four (6.5%) and 2 (6.2%) patients never reached a GFR>40 ml/min/1.73m2 after LDKT, respectively in the UW versus IGL group (p=0.941). The incidence of BPAR during follow-up was 6 (9.7%) and 2 (6.1%) in the UW and IGL group (p=0.546), respectively. The 6 months and 1-year patient survivals were 100% in both study groups. Six months- and 1 year death-censored graft survivals were 100% and 98% versus 100% and 100%, respectively in the UW and IGL group (p=0.590). Discussion This series is the first in literature that demonstrates comparable results on early graft function using IGL-1 perfusion solution versus UW solution in a LDKT program. Conclusion Ex vivo flush and subsequent short static cold storage preservation by IGL-1 perfusion solution demonstrates comparable early graft function in our LDKT program compared to UW perfusion solution.