In this interview Dr. Franklin discusses the data from his two publications examining the UNOS database and efficacy of machine perfusion.1,2
Please tell us something about your current practice with machine perfusion in your Organ Procurement Organization (OPO)?
We traditionally pumped all our kidneys donated after cardiac death and most of our extended-criteria donor kidneys, which make up 35% of our donor population.
What about machine perfusion of standard-criteria donor kidneys (SCDs)?
Our analyses of the United Network for Organ Sharing (UNOS) database (2005–2011) showed that machine perfusion is beneficial in reducing rates of delayed graft function (DGF) in all types of deceased donor kidneys including standard criteria donors1,2 and we suggest that machine perfusion should not be restricted to use in marginal kidneys. Added to this, the advent of portable machine perfusion means that it is possible to have no static cold storage as you go from recovery to device to implantation. These data showed us that in KODA, we were probably underutilizing machine perfusion even for marginal organs. In the 18 months I have been Medical Director here, we have changed this in collaboration with our transplant colleagues and we still have work to do. With data now both in the US and Europe, we see the benefits of machine perfusion for both the organ and the recipient.
How has the approach been working from a practical point of view?
We have changed devices in the past few months and now we have a portable facility with LifePort® Kidney Transporter. We have perfusionists and we pump for a minimum of 4 hours, but usually for 6 hours. If the same transplant center is taking both kidneys we may pump one for longer, while the other is transplanted. So it has been used as both a therapeutic and a storage device. We are not pumping kidneys that are exported.
What are your views on the benefits of hypothermic machine perfusion (HMP) in extending cold times and allowing transplant schedules to move cases to a more elective timeframe?
Pumping in general does help move some of the cases to the morning hours. Even though our state is not large, it has helped. With regards to extending cold times, it is particularly useful on the few occasions where we take imports, which may have cold times of 24 hours or more. In these cases, our transplant surgeons would like to see the donor kidney pumped so they have more information on the kidney.
Has it made a difference to your utilization rate?
There are not enough numbers for us to make a call on that yet. We expect that it will.