Sub-analysis of Machine Preservation Trial

Jochmans I, Moers C, Smits JM, et al. Machine Perfusion Versus Cold Storage for the Preservation of Kidneys Donated After Cardiac Death. Ann Surg 2010;252:756-64

The Machine Preservation Trial (MPT) is the first prospective, international randomized controlled trial comparing machine perfusion on the LifePort with static cold storage.1

Rationale – Rates of 1-year graft survival are significantly reduced in patients who experience delayed graft function (DGF).2 The use of donation after cardiac death (DCD) kidneys and expanded criteria donor (ECD) kidneys is increasing as the number of standard criteria donor (SCD) organs and organs donated after brain death decreases.3 The risk of DGF is higher in DCD and ECD kidneys than in SCD kidneys.4,5 Retrospective studies have suggested that machine perfusion could reduce the risk of DGF in all kidney types from deceased donors.6-8 The Machine Preservation Trial prospectively compared machine perfusion with cold storage with a primary endpoint of DGF.

Study design – 82 DCD kidney pairs were included in the sub-analysis. Kidney pairs were from consecutive donors and from each donor pair, one kidney was randomized to machine perfusion with LifePort® and the other to static cold storage. The trial was conducted in the North Rhine-Westphalia Region of Germany, The Netherlands, and Belgium in collaboration with Eurotransplant and the Deutsche Stiftung Organ transplantation.

Key Clinical Data

In the overall analysis with DCD kidneys, compared with static cold storage, machine perfusion with LifePort:

• Significantly reduces the risk of DGF (adjusted odds ratio, 0.43; p=0.025)
• Reduces the incidence of DGF (53.7% vs 69.5%; p=0.07) Relative Risk 0.77

• Significantly reduces the incidence of functional DGF (19.5% vs. 51.2%; p<0.0001)

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References

1. Moers C, Smits JM, Maathius MH, et al. Machine Perfusion or Cold Storage in Deceased-Donor Kidney Transplantation. N Engl J Med 2009;360:7-19
2. McLaren AJ, Jassem W, Gray DW, et al. Delayed graft function: risk factors and the relative effects of early function and acute rejection on long-term survival in cadaveric renal transplantation. Clin Transplant 1999;13:266-72.
3. Cohen B, Smits JM, Haase B, et al. Expanding the donor pool to increase renal transplantation. Nephrol Dial Transplant 2005;20:34-41.
4. Moers C, Leuvenink HG, Ploeg RJ. Non-heart beating organ donation: overview and future perspectives. Transplant Int 2007; 20:567-75.
5. Snoeijs MG, Schaefer S, Christiaans MH, et al. Kidney transplantation using elderly non-heart-beating donors: a single-center experience. Am J Transplant 2006;6:1066-71.
6. Wight J, Chilcott J, Holmes M, Brewer N. The clinical and cost-effectiveness of pulsatile machine perfusion versus cold storage of kidneys for transplantation retrieved from heart-beating and non-heartbeating donors. Health Technol Assess 2003;7:1-94.
7. Schold JD, Kaplan B, Howard RJ, Reed AI, Foley DP, Meier-Kriesche HU. Are we frozen in time? Analysis of the utilization and efficacy of pulsatile perfusion in renal transplantation. Am J Transplant 2005;5:1681-8.
8. Wight JP, Chilcott JB, Holmes MW, Brewer N. Pulsatile machine perfusion vs. cold storage of kidneys for transplantation:a rapid and systematic review. Clin Transplant 2003;17:293-307.

Plata-Munoz J, Muthusamy A, Elker D et al. Beneficial Effect of Preservation by Machine Perfusion on Postoperative Outcome Of Kidneys From Controlled Donors After Cardiac Death. International Transplant Congress. 2010

Rationale – Studies have suggested that preservation by machine perfusion reduces the incidence of DGF following transplant with DCD kidneys.

Study design – A comparative analysis was performed between 34 DCD kidneys preserved by cold storage and 83 DCD kidneys preserved with machine perfusion on the LifePort. The DCD kidneys were then grouped according to their risk of post-transplant dysfunction to compare the effect of preservation method on optimal, borderline and marginal grade kidneys.

Key Clinical Data

In the overall analysis with DCD kidneys, compared with static cold storage, machine perfusion:

• Significantly lowered the incidence of DGF (45% vs. 79%; p<0.0001)
• Significantly reduced the length of hospitalization (10 days vs. 14 days; p<0.001)
• Significantly improved 1-year and 5-year graft function (152 vs. 193 mmol/L; p=0.001, 156 vs. 186 mmol/L; p<0.002)
• Significantly improved 5-year graft function in optimal grade kidneys (111 vs. 170 mmol/L; p=0.001)
• Significantly improved 1-year and 5-year graft function in borderline grade kidneys (163 vs. 207 mmol/L; p=0.001, 183 vs. 235 mmol/L; p=0.01)

Published Abstract