Sub-analysis of Machine Preservation Trial

Treckmann J, et al. Machine perfusion versus cold storage for preservation of kidneys from expanded criteria donors after brain death. Transpl Int 2011;24:548–554.

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 DGF.2 The use of ECD 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 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

Study design – 91 ECD kidney pairs were included in the sub-analysis. 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 Germany, The Netherlands and Belgium, in collaboration with Eurotransplant and the Deutsche Stiftung Organ transplantation. Donor kidneys were machine perfused from retrieval to transplantation.

Key Clinical Data

In the analysis of ECD kidneys compared with static cold storage (CS), machine perfusion (MP) with LifePort:

• Significantly reduced the odds of experiencing a delay in recovery of kidney function; 54% lower (odds ratio: 0.46; p=0.047)
• Significantly improved 1-year graft survival (92.3% vs. 80.2%; p=0.02)

• Significantly improved 1-year graft survival in kidneys with DGF (44% difference: 85% vs. 41%; p=0.003)

• Significantly reduced the incidence of primary non-function (12% vs. 3%; p=0.04)

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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.