EXAM: Ex vivo allograft monitoring dashboard for the analysis of hypothermic machine perfusion data in deceased-donor kidney transplantation

Abstract

Background: Deceased-donor kidney allografts are exposed to injury during ex vivo transport due to the lack of blood oxygen supply. Hypothermic machine perfusion (HMP) is effective in reducing the risk of delayed graft function in kidney transplant recipients compared to standard cold storage. However, there is no software implementation available to read, process and analyse HMP data for state-of-the-art visualization and quality control in an analytics dashboard. Results: We implemented the tool EXAM (ex vivo allograft monitoring) which includes an interactive analytics dashboard. The backbone is a collection of functions in the R programming language to read, process and analyse HMP data from the LifePort kidney transporter (Organ Recovery Systems, USA). Time series for pressure, flow rate, organ resistance and temperature are visualized and relevant statistical indicators have been developed. We highlight a few showcases for data analysis and quality control. Conclusions: Allograft monitoring during transport and retrospective HMP data analysis are essential for quality control and novel research. EXAM is freely available software written in the R programming language that can be easily deployed by statisticians and data scientists to enable quality control at transplant organizations that use LifePort kidney transporters. The open development enables collaboration to further extend EXAM, e.g. integrating data from other kidney transporters or even form other organs into a unified state-of-the-art monitoring tool.

Preoperative Risk Assessment of Early Kidney Graft Loss

“…Expert opinions and reviews of predictors of graft outcome served to choose the predictors for analysis (Figure S1, SDC, http://links.lww.com/TXD/A652). 11,12 Endpoints and Outcomes EGL, in which graft failure, defined as retransplantation or return to dialysis during the first posttransplant year (early allograft failure or primary nonfunction), served as the primary-dependent outcome measure. Considering that transplantation increases the risk of death in the immediate posttransplant period and the patient dying practically constitutes a transplant failure, we augmented a secondary-dependent outcome measure of graft failure or death (all-cause graft failure) during the first posttransplant year.…”