Machine perfusion: not just for marginal kidney donors

18 January 2016 - 18 January 2016  // 

In a recently published article, researchers set out to determine the potential benefit of hypothermic machine perfusion (HMP) for standard criteria donors (SCDs). Data from the UNOS database from 2005 and 2011 from all adults undergoing de novo kidney transplantation from SCDs were reviewed. The primary endpoint was delayed graft function (DGF), defined as dialysis within 7 days of transplantation. In total, 36,323 patients met the inclusion criteria. Of these, 9882 received kidneys that had undergone HMP and 26,441 patients received kidneys preserved via static cold storage (SCS). Donors of HMP kidneys were significantly older compared with their SCS counterparts (36.8 years vs 33.1 years, respectively; p<0.001) and terminal creatinine levels in HMP kidneys were significantly higher than SCS kidneys (1.4 mg/dl vs 1.1 mg/dl, respectively: p<0.001). The authors controlled for differences between groups in three ways: by using multivariable logistic regression, adjusting for donor and recipient characteristics that were significantly associated with DGF; by comparing DGF rates in a group of propensity score-matched HMP versus SCS recipients; and by conducting paired-kidney analyses, in which one kidney underwent HMP and one underwent SCS.

  • Unadjusted rates of DGF were 18.6% and 22.4% in the HMP and SCS groups, respectively (p<0.001)
  • After propensity score matching, both the HMP and the SCS groups included 8,929 patients each, with DGF occurring in 16.8% and 25.3%, respectively (p<0.001)
  • In the paired-kidney analysis, the HMP and SCS groups each included 1665 recipients and DGF rates were 16.7% and 23.4%, respectively (p<0.001)

Although the authors noted that their study was limited by its observational nature, the authors concluded that HMP is beneficial in reducing rates of DGF even in SCD kidneys, and therefore should not be restricted to use in marginal kidneys.

Cannon RM, et al. Am Surg.2015;81:550–6.