Dion, et al. BJU Int 2015;116(6):932–7.
This retrospective study evaluated the impact of hypothermic machine perfusion (HMP) on Doppler ultrasound parameters and graft function in paired kidneys (n=15 pairs), where the kidney maintained with HMP had a longer cold ischemia period. Potential benefits in kidneys obtained from donation after cardiac death (DCD) versus donation after brain death (DBD) subgroups were also investigated.
Post-operative resistive indices on day 7 were significantly lower in the HMP cohort compared with the SCS cohort (0.75 ± 0.11 vs 0.83 ± 0.10, respectively, p=0.005). This statistical difference was maintained in DBD and DCD subgroups (p=0.035 and 0.023, respectively) and resistive indices were lower in the DBD versus DCD cohort on post-transplant days 1 and 7 (p=0.02 and <0.001, respectively). Glomerular filtration rate (GFR) was assessed in recipients 2 years
post-transplantation. HMP led to persistently higher eGFRs over this time period (p=0.013), and improvements in GFR were greatest in the DCD versus the DBD cohorts (p=0.004 and 0.653, respectively). Improvements were observed for the DCD cohort even in the initial weeks after transplantation (p=0.008).
This study demonstrated that despite longer cold-ischemia times for the HMP cohort, kidneys maintained with HMP have excellent function compared with kidneys maintained in SCS, and that HMP improves function in DCD grafts. This study also suggests that HMP may improve 2-year graft function in kidneys obtained from DCD.