Hypothermic Machine Perfusion Reduces Delayed Graft Function and Improves One-Year Graft Survival of Kidneys from Expanded Criteria Donors: A Meta-Analysis

Baoping Jiao,Hao Liu,Donghua Cheng,Shurong Liu,Yongfeng Liu,Ying Cheng,Valquiria Bueno

doi:10.1371/journal.pone.0081826

Abstract

BackgroundExpanded criteria donors (ECDs) are currently accepted as potential sources to increase the donor pool and to provide more chances of kidney transplantation for elderly recipients who would not survive long waiting periods. Hypothermic machine perfusion (HMP) is designed to mitigate the deleterious effects of simple cold storage (CS) on the quality of preserved organs, particularly when the donor is in a marginal status.MethodsWe compared the transplant outcomes in patients receiving ECD kidneys with either HMP or CS graft preservation. Articles from the MEDLINE, EMBASE and Cochrane Library databases were searched and all studies reporting outcomes from HMP versus CS methods of kidney preservation were included in this meta-analysis. The parameters analyzed included the incidence of delayed graft function (DGF), primary non-function (PNF) and one-year graft and patient survival.ResultsA total of seven studies qualified for the review, involving 2374 and 8716 kidney grafts with HMP or CS preservation respectively, all from ECD donors. The incidence of delayed graft function (DGF) was significantly reduced with an odd ratio(OR) of 0.59 (95% CI 0.54–0.66, P<0.001) and one-year graft survival was significantly improved with an OR of 1.12 (95% CI 1.03–1.21, P = 0.005) in HMP preservation compared to CS. However, there was no difference in the incidence of PNF (OR 0.54, 95% CI 0.21–1.40, P = 0.20), and one-year patient survival (OR 0.98, 95% CI 0.94–1.02, P = 0.36) between HMP and CS preservation.ConclusionsHMP was associated with a reduced incidence of DGF and an with increased one-year graft survival, but it was not associated with the incidence of PNF and one-year patient survival.

Highlights

Kidney transplantation is the optimal treatment for patients with end-stage renal disease(ESRD) [1]
It has been reported that SC was unable to fully protect Expanded criteria donors (ECDs) kidneys, while Hypothermic machine perfusion (HMP) could mitigate the deleterious effects of cold storage (CS), reducing the incidence of delayed graft function (DGF) for ECD kidney transplantations [14,15]
We found that the incidence of primary non-function (PNF) was significantly lower in HMP preservation compared to CS, with an odds ratios (ORs) of 0.28(95% confidence intervals (CIs) 0.12–0.63), with no heterogeneity(X2 = 0.69,P = 0.88, I2 = 0%),fixed-effect model(Figure 3)

Summary

Introduction

Kidney transplantation is the optimal treatment for patients with end-stage renal disease(ESRD) [1]. Because of a persistent donor organ shortage, kidneys from expanded criteria donors (ECDs) are currently accepted by many centers and have been successfully transplanted to increase the donor pool [2,3], thereby facilitating timely kidney transplantation for elderly recipients who would not survive long waiting periods [4,5] ECDs are defined as allografts from deceased donors older than 60 years of age and those from donors aged 50–59 years old with at least two of the followings characteristics: history of hypertension, serum creatinine greater than 1.5 mg/dL or cerebrovascular as the cause of death[6]. Expanded criteria donors (ECDs) are currently accepted as potential sources to increase the donor pool and to provide more chances of kidney transplantation for elderly recipients who would not survive long waiting periods. Hypothermic machine perfusion (HMP) is designed to mitigate the deleterious effects of simple cold storage (CS) on the quality of preserved organs, when the donor is in a marginal status

Methods

Results

Conclusion