Therapeutic Hypothermia or Hypothermic Machine Perfusion (HMP) which is best for Kidney Transplant Outcomes?

In 2023, Malinoski et al. published the results from a pragmatic, adaptive, prospective, randomized trial that was conducted between August 10, 2017, and May 21, 2020 involving six OPOs in the US.  They sought to determine whether targeted mild hypothermia is as effective as hypothermic machine perfusion (HMP) of kidneys obtained from brain dead donors. They compared the outcomes from kidney transplants of 1349 kidneys divided into 3 groups: hypothermia group (359 kidneys), hypothermic machine perfusion (511 kidneys), and a combination of both hypothermia and HMP (479 kidneys).  

Overall, they found that:  

  • Incidence of DGF was lower in the HMP group compared to the hypothermia group (19% vs. 30%) 
  • Odds ratios showed that the non-inferiority of hypothermia to HMP was not established (OR 1.56) 
  • One year graft survival was similar across all three groups.

They concluded that HMP was superior to hypothermia alone in reducing the incidence of delayed graft function, and that a combination of both therapies was not superior to HMP alone.

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