Cold Machine Perfusion Versus Static Cold Storage of Kidneys Donated After Cardiac Death: A UK Multicenter Randomized Controlled Trial

Abstract

One third of deceased donor kidneys for transplantation in the UK are donated following cardiac death (DCD). Such kidneys have a high rate of delayed graft function (DGF) following transplantation. We conducted a multicenter, randomized controlled trial to determine whether kidney preservation using cold, pulsatile machine perfusion (MP) was superior to simple cold storage (CS) for DCD kidneys. One kidney from each DCD donor was randomly allocated to CS, the other to MP. A sequential trial design was used with the primary endpoint being DGF, defined as the necessity for dialysis within the first 7 days following transplant. The trial was stopped when data were available for 45 pairs of kidneys. There was no difference in the incidence of DGF between kidneys assigned to MP or CS (58% vs. 56%, respectively), in the context of an asystolic period of 15 min and median cold ischemic times of 13.9 h for MP and 14.3 h for CS kidneys. Renal function at 3 and 12 months was similar between groups, as was graft and patient survival. For kidneys from controlled DCD donors (with mean cold ischemic times around 14 h), MP offers no advantage over CS, which is cheaper and more straightforward.

Hypothermic Machine Perfusion in Kidney Transplantation: Back to the Future?

“…There were no differences in PNF, acute rejection, and 1-year graft survival rates between the two groups. Similar 1-year graft survival (93.3% vs. 97.8%) and renal function were reported by the randomized clinical trial performed in UK in 2010 [12]. Surprisingly, the study showed no differences in DGF rates between HMP and cold storage (58% vs. 56%) but the fact that some of the kidneys allocated to HMP were actually put on ice before effective pumping may somehow explain this unexpected finding.…”

Ex Vivo Perfusion Characteristics of Donation After Cardiac Death Kidneys Predict Long-Term Graft Survival

“…As data were not available for all patients some of the confidence intervals were wide, increasing the risk of a type 2 error. We also did not have data regarding delayed graft function which was related with machine perfusion parameters in some studies [15].…”

“…However, Moers have stated later on that three years after transplantation machine perfusion MP had no advantage over cold storage in terms of graft survival in DCD kidney transplantation. In addition, a multicentre study conducted in the UK showed no advantage of machine perfusion MP over cold storage in terms of incidence of delayed graft function, renal function and 1 year graft and patient survival [15]. A meta-analysis also showed that machine perfusion decreased the incidence of delayed graft function compared to static cold storage but graft and patient survival at 1 year were similar [23].…”

Kidney donation after cardiac death

“…Machine perfusion has been shown to be beneficial for ECD kidneys [88] , but the results from a United Kingdom based trial comparing machine perfusion with cold storage were equivocal [89] . The effect of machine perfusion on DCD kidneys may decrease DGF by up to 38% but has no effect on longterm function [6,90] .…”