POS-707 USE OF HYPOTHERMIC MACHINE PERFUSION IN KIDNEY TRANSPLANTATION

Abstract

Delayed graft function (DGF) is associated with an increased risk of graft loss. The use of cold hypothermic machine perfusion (HMP) has been shown to reduce the incidence of DGF in kidney transplant recipients (KTRs), especially when extended-criteria donors (ECDs) are used. In addition, HMP can improve graft survival in the first years after transplantation. However, there is a paucity of data on the determinants of HMP use in real-life setting. We aimed to determine the factors associated with the use of MP in a cohort of donors and KTRs. We collected data on consecutive brain-dead donors admitted to an organ procurement organization (OPO) and their KTRs between June 2013 and December 2018 in 5 adult transplant centers across the province of Quebec in Canada. There is no standardized protocol for the use of HMP in the province of Quebec. The use of HMP is left at the discretion of the surgeon recovering organs. However, a HMP device was available for every organ recovered at the organ procurement organization. Generalized estimating equations were used to predict the use of HMP. The cohort included 159 deceased donors and their 281 KTRs. Thirty-three percent of donors were ECDs, and 59% of KTRs received organs placed on HMP. The median cold ischemia time (CIT) was 12.4 (IQR 7.9-16.2) hours. In univariate analysis, none of the donors’ characteristics were associated with the use of HMP. ECD represented 33% of KTR on HMP vs. 34% of those not receiving HMP (p=0.82). For KTRs, in univariate analysis, race (non-Caucasian), CIT, use of basiliximab/alemtuzumab, year of transplant and KTR center were associated with the use of HMP. We further identified the characteristics of KTR centers associated with HMP use. In multivariate analysis, longer CIT (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.06-1.22), longer distance between KTR center and OPO (OR 0.11, 95%CI 0.04-0.29), as well as KTR after 2013 remained significantly associated with use of HMP. We found that use of HMP was strongly associated with the transplant center where the surgeons practiced, suggesting that surgeon preference/training plays an important role in determining the use of HMP. Availability of HMP at the time of organ procurement might also be limited by logistic issues such as difficulty in returning the device to the OPO. Further studies aimed at determining the reasons underlying the barriers precluding the use of HMP could help increasing it use.