A team from Warsaw Medical University, Poland, has reported results from a prospective, randomized, trial comparing Organ Recovery System’s LifePort®, a pressure driven (PD) device, with Waters Medical Systems’ RM3, a flow driven (FD) device.1 This is the first time the two systems have been compared in patients receiving deceased donor kidneys. The aim of the study was to evaluate any potential impact on kidney transplant outcome between the two systems.
A total of 50 kidneys were retrieved from 25 deceased donors, of which 24 were from 12 ECD. Of the 50 recipients, 25 received a PD-perfused kidney and 25 received a FD-perfused kidney. There were no differences seen in kidney weight before or after cold ischemia time (mean time was 28 hours for both groups). Although not significant, renal flow was higher in FD kidneys; however, renal resistance was significantly lower in PD kidneys from the first hour until the end of perfusion. Biomarker analysis found no differences in mean activation of TNFα, NGAL or KIM-1 in the perfusion solutions, although caspase-3 was significantly higher in the fourth hour of perfusion in FD kidneys. No difference was seen in delayed graft function (DGF) between the two cohorts (32%). Interestingly, in patients with DGF, the mean number of post-transplant dialysis sessions was significantly lower in PD patients compared with the FD group (2.65 versus 4.66; p=0.004). While overall 1-year graft survival was 88% (44/50), in PD patients it was 96% (24/25) and in FD patients 80% (20/25; p=0.07). In ECD kidneys, 1-year graft survival was 92% (11/12) in the PD group and 66% (8/12) in the FD group (p=0.09). Also noteworthy are the significantly lower mean pressures registered on the PD device, which data have already shown to be associated with lower activation of von Willebrand factor, a marker of endothelial injury.2 The group believes that these data warrant further investigation in a larger study in order to improve the power of the results.