Impact of machine perfusion after long static cold storage on delayed graft function incidence and duration and time to hospital discharge.

Abstract

Delayed graft function (DGF) is very high in our center (70%-80%), and we usually receive a kidney for transplant after more than 22hours of static cold ischemia time (CIT). Also, there is an inadequate care of the donors, contributing to a high rate of DGF. We decided to test whether machine perfusion (MP) after a CIT improved the outcome of our transplant patients. We analyzed the incidence of DGF, its duration, and the length of hospital stay (LOS) in patients who received a kidney preserved with MP after a CIT (hybrid perfusion-HP). We included 54 deceased donors kidneys preserved with HP transplanted from Feb/13 to Jul/14, and compared them to 101 kidney transplants preserved by static cold storage (CS) from Nov/08 to May/12. The median pumping time was 11hours. DGF incidence was 61.1% vs 79.2% (P=.02), median DGF duration was 5 vs 11days (P<.001), and median LOS was 13 vs 18days (P<.011), for the HP compared to CS group. The observed reduction of DGF with machine perfusion did not occur in donors over 50years old. In the multivariate analysis, risk factors for DGF, adjusted for CIT, were donor age (OR, 1.04; P=.005) and the absence of use of MP (OR, 1.54; P=.051). In conclusion, the use of HP contributed to faster recovery of renal function and to a shorter length of hospital stay.