Effect of Hypothermic Machine Perfusion on the Preservation of Kidneys Donated After Cardiac Death: A Single‐Center, Randomized, Controlled Trial

Abstract

To assess the application of a hypothermic machine perfusion device (LifePort) in kidney transplantation from donation after cardiac death (DCD) donors, 24 pairs of DCD kidneys were randomly divided into two groups: one of the paired kidneys from the same donor was perfused with the LifePort machine (hypothermic machine perfusion [HMP]), and the contralateral kidney was prepared using common static cold preservation (CCP). The two groups were compared with respect to the incidence of delayed graft function (DGF), level of graft function, and pathological changes in time-zero biopsy specimens. The incidence of DGF was 16.7 and 37.5% in the HMP and CCP groups, respectively; the difference between the two groups was statistically significant (P < 0.05). The incidence of acute rejection was 4.1 (1/24) and 8.3% (2/24) in the HMP and CCP groups, respectively; this difference was not statistically significant (P > 0.05). Forty-eight kidney patients were followed up for 6 months, and the two groups of recipients all survived, yielding a survival rate of 100%. The mean 6-month serum creatinine levels were 98.7 ± 23.6 µmol/L in the HMP group and 105.3 ± 35.1 µmol/L in the CCP group; there was no significant difference between the two groups. HMP can reduce the incidence of DGF in DCD kidneys, and this effect is greater for expanded criteria donors kidneys. HMP can also improve early renal function.

Hypothermic Machine Perfusion Versus Static Cold Storage in Deceased Donor Kidney Transplantation: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

“…Eventually we included 13 randomized controlled trials comparing HMP with SCS of donor kidneys for deceased donor kidney transplantation, including 2048 donor kidneys and 2048 kidney transplant recipients (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Eventually we included 13 randomized controlled trials comparing HMP with SCS of donor kidneys for deceased donor kidney transplantation, including 2048 donor kidneys and 2048 kidney transplant recipients (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24).…”

“…In two trials, the definition of DGF was not provided (18,19). One trial defined DGF as one of the following: postoperative anuria or oliguria and the need to reinitiate hemodialysis in the first week after surgery; or hemodialysis was not reinitiated, but serum creatinine was greater than 400 µmol/L at 7 days after surgery (14). One trial defined DGF as one of the following: postoperative anuria or oliguria and the need to reinitiate hemodialysis in the first week after surgery; or hemodialysis was not reinitiated, but serum creatinine was greater than 400 µmol/L at 7 days after surgery (14).…”

“…Two trials defined DGF as the need for dialysis after transplantation (21,23). Five RCTs found HMP significantly reduced the rates of DGF (13)(14)(15)17,20). Five RCTs found HMP significantly reduced the rates of DGF (13)(14)(15)17,20).…”

“…One trial defined DGF as one of the following: postoperative anuria or oliguria and the need to reinitiate hemodialysis in the first week after surgery; or hemodialysis was not reinitiated, but serum creatinine was greater than 400 µmol/L at 7 days after surgery (14). Moers et al (17) and Wang et al (14) reported that HMP can reduce the incidence of DGF in DCD kidneys. Other RCTs did not show a statistical difference between HMP and SCS.…”

“…Six studies provided the rate of acute rejection (13,14,(16)(17)(18)20). However, it was reported at variable time points after surgery, so it was not possible to perform a meta-analysis.…”