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Abstract

Objectives: The logistics of deceased-donor renal transplants are largely affected by cold ischemia time. However, to attain successful outcomes, other issues must be considered. Extending cold ischemia time to accommodate these issues would be valuable. We investigated the role of hypothermic machine perfusion to extend cold ischaemia time. Materials and Methods: Deceased-donor kidneys were allocated to a storage method, depending on predicted time to operation. Kidneys to be transplanted from 8:00 AM to 8:00 PM in the transplant room remained in static cold storage. If predicted operating time was out of hours, the kidney was transferred to hypothermic machine perfusion and transplanted at the earliest opportunity on the dedicated transplant list. Results: There were 74 kidneys transplanted from hypothermic machine perfusion and 101 kidneys from static cold storage. Median cold ischemia time was 23.85 hours in the hypothermic machine perfusion group, compared with 13 hours in the static cold storage group (P ≤ .0001). There were 20 kidneys (27%) from hypothermic machine perfusion that had delayed graft function, compared with 47 kidneys (47%) in the static cold storage group (P = .012). There were no other significant differences in graft or postoperative complications. Conclusions:This study demonstrated that improved early graft outcomes can be achieved following longer cold ischemia time by using hypothermic machine perfusion rather than static cold storage. This effect is likely multifactorial including the inherent effects of hypothermic machine perfusion, improved recipient preparation, and possibly better perioperative conditions.

Perfusion Techniques in Kidney Allograft Preservation to Reduce Ischemic Reperfusion Injury: A Systematic Review and Meta-Analysis

“…There were 2025 and 3229 patients receiving grafts treated with NRP and ISP, respectively. The NRP and ISP cohorts had similar mean donor age (48.1 Forest plot for post-transplant serum creatinine (mg/dL) between MP and SCS [9,15,17,24,27,28,31,[40][41][42][43][44][45]48,49,51,57].…”

“…There were 22 (53.7%) studies that involved kidney pairs [17,[20][21][22]24,28,[30][31][32][33][34]36,41,[44][45][46][47][48]52,57]. Studies were conducted across the world; 25 (61.0%) were single-center efforts [9,17,22,[24][25][26][27][28][29][30]35,[38][39][40][41][42][43]45,46,48,49,51,54,55,57], while 16 (39.0%) involved multiple centers [15,20,21,23,[31]…”

“…A total of 39 studies investigated the effects of HMP [9,17,, while 2 studies focused on NMP [15,72]. Among MP studies, 10 (24.4%) were retrospective studies [23,29,[37][38][39]42,43,49,50,54], 17 (41.5%) were prospective studies [9,17,21,22,[24][25][26][27][28]35,40,41,46,48,55,57], and 14 (34.2%) were randomized control trials [15,20,[30][31][32][33][34]36,44,47,[51][52][53]56]. There were 22 (53.7%) studies that involved kidney pairs [17,[20][21][22]24,28,<...…”

“…Figure 7. Forest plot for post-transplant serum creatinine (mg/dL) between MP and SCS[9,15,17,24,27,28,31,[40][41][42][43][44][45]48,49,51,57].…”

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“…A Cochrane database review showed that open donor nephrectomy is associated with a higher risk of DGF than laparoscopic donor nephrectomy (relative risk of 1.09, 95% CI, 0.52-2.30). 61 Interestingly, results of kidney transplant between unrelated individuals in Western countries indicate that immunologic factors such as HLA matching, ABO incompatibility, 62 and longer cold ischemia time using advanced technology such as hypothermic machine perfusion 63 have minimal effect on DGF. Therefore, further studies are certainly warranted to investigate the effect of these factors on DGF from a Middle Eastern perspective to ensure high success rate in terms of graft function.…”