Machine Preservation Trial: prognostic value of renal resistance

Jochmans I, Moers C, Smits JM, et al. The Prognostic Value of Renal Resistance During Hypothermic Machine Perfusion of Deceased Donor Kidneys. Am J Transplant 2011;11:2214-2220.

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

Rationale – Renal resistances during machine perfusion are believed to be predictive of transplant outcome and are frequently used to discard kidneys prior to transplant.2 However, renal resistance threshold values have never been determined prospectively.

Study design – 336 kidney pairs (672 recipients) were included in the MPT. Kidney pairs were from consecutive donors and all commonly-used deceased-donor kidney types were included. 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. In the machine preservation group, renal resistance was recorded to determine impact on DGF, PNF and graft survival. The renal resistance values of 302 kidneys were analysed.

Analysis of renal resistance:

• Renal resistance at the end of hypothermic machine perfusion is an independent risk factor for DGF (odds ratio 38.1; p=0.026)
• Renal resistance at the end of hypothermic machine perfusion is an independent risk factor for 1-year graft failure (hazard ratio 12.33; p=0.004)
• Renal resistance is an important additional factor that can be used to assess quality of kidney grafts, but should not be used as a stand-alone assessment tool in the decision to accept or discard organs

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. Sung RS, Christensen LL, Leichtman AB, et al. Determinants of discard of expanded criteria donor kidneys: impact of biopsy and machine perfusion. Am J Transplant 2008;8: 783-792.

Read the paper (subscription required for full-text): The Prognostic Value of Renal Resistance during Hypothermic Machine Perfusion of Deceased Donor Kidneys

Machine-measured renal resistance

Yushkov YY, Alvarez-Casas J, S. Dikman S, et al. Machine-Measured Renal Resistance (MMRR) is the Most Sensitive Tool for Prediction of Early Renal Allograft Survival. International Transplant Congress 2010.

Rationale – to investigate the significance of kidney graft and donor parameters as predictors of 1-year graft survival.

Study design – a retrospective analysis was performed on 470 pre-selected kidneys for transplantation that were machine perfused with LifePort®.

Analysis of renal resistance:

Machine-measured renal resistance at 3 hours is the earliest significant predictor of 1-year graft survival.

Published abstract

Machine-Measured Renal Resistance (MMRR) is the Most Sensitive Tool for Prediction of Early Renal Allograft Survival - ITC 2010