Hypothermic machine perfusion can safely prolong cold ischemia time in deceased donor kidney transplantation. A retrospective analysis on postoperative morbidity and graft function

Abstract

In deceased donor kidney transplantation (KT), a prolonged cold ischemia time (CIT) is a negative prognostic factor for KT outcome, and the efficacy of hypothermic machine perfusion (HMP) in prolonging CIT without any additional hazard is highly debated. We conducted a retrospective study on a cohort of 154 single graft deceased donor KTs, in which a delayed HMP, after a preliminary period of static cold storage (SCS), was used to prolong CIT for logistic reasons. Primary outcomes were postoperative complications as well as 1 year graft survival and function. 73 cases (47.4%) were managed with HMP and planned KT, while 81 (52.6%) with SCS and urgent KT. The median CIT in HMP group and SCS group was 29 hour:57 minutes [27-31 hour:45 minutes] and 11 hour:25 minutes [9-14 hour:30 minutes], respectively (P < .001). The period of SCS in the HMP group was significantly shorter than in the SCS group (10 vs. 11 hour:25 minutes, P = .02) as well as the prevalence of expanded criteria donors was significantly higher (43.8% vs. 18.5%, P < .01). After propensity score matching for these two baseline characteristics, the HMP and SCS groups showed comparable outcomes in terms of delayed graft function, vascular, and urologic complications, infections, and episodes of graft rejection. At 1 year follow-up, serum creatinine levels were comparable between the groups. Therefore, the use of HMP to prolong the CIT and convert KT into a planned procedure seemed to have an adequate safety profile, with outcomes comparable to KT managed as an urgent procedure and a CIT nearly three time shorter. K E Y W O R D Scold ischemia time, delayed graft function, hypothermic machine perfusion, kidney transplant morbidity, kidney transplantation How to cite this article: Adani GL, Pravisani R, Tulissi P, et al. Hypothermic machine perfusion can safely prolong cold ischemia time in deceased donor kidney transplantation. A retrospective analysis on postoperative morbidity and graft function.

PO2 21% oxygenated hypothermic machine perfusion in kidney transplantation: Any clinical benefit?

“…Such data may possibly support further clinical investigations on prolonged, supraphysiological oxygenation during HMP and/or on the effect of oxygenated HMP in non-ECD KT. Conversely, they may also be interpreted as an additional evidence that the benefit of oxygenation, although metabolically evident at a molecular level, [6][7][8][9][10] may not currently result in a real clinical advantage. Under this perspective, studies on oxygen carries, preservation solutions with specific antioxidant and/or antiinflammatory agents or normothermic MP may represent promising strategies to further improve KT outcomes.…”

“…10 KT procedure and postoperative management have been described elsewhere. 9 Primary endpoints of the study were delayed graft function, defined as the need for dialysis within the first 7-days post-KT, and 1-year cumulative incidence of graft loss, defined as graft nephrectomy or return to dialysis;…”

“…Graft management with HMP was decided only on the base of logistic reasons and it was started after a preliminary period of static cold storage (SCS) following organ procurement, as previously reported. 9 Oxygenation was performed at pO 2 21% (corresponding to an oxygen pressure in the perfusate of 8-18 kPa), following the manufacturer's guidelines. KPS-1 was used as perfusion solution in both HMP devices.…”

Urological Complications in Kidney Transplant Recipients: Analysis of the Risk Factors and Impact on Transplant Outcomes in the Era of “Extended Criteria Donors”

“…In KT, the ischemia-reperfusion damage-especially for prolonged ischemia times [46]-could, on the one hand, cause DGF, while on the other hand cause edema of the ureteral wall, remodeling of the muscular layer and fibrosis, contributing to the development of ureteral stricture, which are the most common UCs after KT [35]. In this setting, the adoption of machine preservation-as a hypothermic machine perfusion-could not only reduce the incidence of DGF, but also of UC with consequent improved graft survival, especially in ECD [47,48]. However, in the current study, none of the used grafts had been preserved with machine perfusion, therefore, further trials should focus on the correlation of ECD grafts (treated with machine preservation) and UC.…”

Effect of Long Cold Ischemia Time of Kidneys from Aged Donors on Prognosis of Kidney Transplantation

“…It is generally believed that HMP is superior to SCS in preservation effect. There are also many reports comparing HMP with SCS, which suggest that the incidence of DGF in HMP is lower, and the long-term survival rate of grafts is higher [ 59 – 63 ].…”