Single centre experience of hypothermic machine perfusion of kidneys from extended criteria deceased heart-beating donors: a comparative study

25 June 2015 - 25 June 2015  // 

Forde JC et al. Ir J Med Sci 2014 Dec 5. doi: 10.1007/s11845-014-1235-8 [Epub ahead of print]

A retrospective analysis was performed in 93 patients who had received expanded criteria donor (ECD) kidneys over a 4-year period from July 2007 to July 2009. These ECD kidneys were stored using hypothermic machine perfusion (HMP) using a LifePort Kidney Transporter and were compared with an age-matched group, who received ECD kidneys between 2003 and 2007, where the kidney was stored using static cold storage (SCS).

Delayed graft function (DGF) occurred in 17.2% (16/93 patients) with a mean of 6 days. In the SCS group, DGF occurred in 25.8% (24/93) patients with a mean of 8.1 days. 1-year graft survival rate was shown to be marginally improved in the HMP group (97.85 vs. 96.77%). The mean cold ischemic time (CIT) in kidneys prior to transplantation was slightly lower in the HMP group compared with the SCS group. The authors report that this is consistent with an overall reduction over the past decade in CIT for all donor kidneys in their institution, likely a result of the introduction of prospective tissue typing.

The DGF findings reported in this study support previous studies demonstrating that HMP is associated with improved DGF rates. Owing to the fact that kidney transplantations from ECD exhibit a higher rate of DGF, they are also often associated with higher post-operative costs as a result of prolonged hospital stay in addition to the need for dialysis and further diagnostic procedures. Reduced need for dialysis following transplantation represents a considerable benefit to both patients and transplant units, in terms of morbidity, expense and resources. 

The authors conclude that HMP of kidneys reduces the incidence of DGF and is associated with a significant improvement in serum creatinine levels at months 1 and 3.