One-year results of a prospective, randomized trial comparing two machine perfusion devices used for kidney preservation

Abstract

SummaryStudies have shown beneficial effects of machine perfusion (MP) on early kidney function and long-term graft survival. The aim of this study was to investigate whether the type of perfusion device could affect outcome of transplantation of deceased donor kidneys. A total of 50 kidneys retrieved from 25 donors were randomized to machine perfusion using a flow-driven (FD) device (RM3; Waters Medical Inc) or a pressure-driven (PD) device (LifePort; Organ Recovery Systems), 24 of these kidneys (n = 12 pairs; 48%) were procured from expanded criteria donors (ECD). The primary endpoints were kidney function after transplantation defined using the incidence of delayed graft function (DGF), the number of hemodialysis sessions required, graft function at 12 months, and analyses of biopsy. DGF was similar in both groups (32%; 8/25). Patients with DGF in the FD group required a mean of 4.66 hemodialysis sessions versus 2.65 in the PD group (P = 0.005). Overall, 1-year graft survival was 80% (20/25) vs. 96% (24/25) in the FD and PD groups. One-year graft survival of ECD kidneys was 66% (8/12) in the FD group versus 92% (11/12) in the PD group. Interstitial fibrosis and tubular atrophy were significantly more common in the FD group -45% (5/11) vs. 0% (0/9) (P = 0.03) in PD group. There were no differences in creatinine levels between the groups. Machine perfusion using a pressure-driven device generating lower pulse stress is superior to a flow-driven device with higher pulse stress for preserving kidney function.

The promise of organ and tissue preservation to transform medicine

“…Although leaps forward in machine perfusion 33–41,65–67 , organ cryopreservation 26,27,68 , understanding scientific mechanisms of ischemic injury and metabolic regulation 29–32,41 , and other areas have created a blueprint for transforming organ preservation, today maximum clinical organ preservation times are measured in hours, varying according to the organ transplanted, and necessitate transplantation almost immediately after the organ is recovered (http://www.nedonation.org/donation-guide/organ/acceptable-ischemic-times). Organs are rushed to their destinations, often by jet, or by helicopter flight straight to a landing pad on the transplant center rooftop.…”

“…This creates exciting prospects for translating the ‘suspended animation’ programs of animals, such as the arctic ground squirrel 153 and even tardigrade 154 , into tools for organ and tissue preservation. This decade has also seen rapid advances in ex vivo perfusion platforms 33,34,36–38,41,66 , which can be adapted to recapitulate aspects of an organ’s in vivo environment, condition it for storage or transport in a hypometabolic state, or enhance recovery from stresses experienced during donor death or the preservation period 40,155–158 . By building on, and combining, these innovations from different disciplines, we are now poised to create a new generation of organ and tissue preservation capabilities driven by both public and private sector funding (Box 1).…”

“…The past decade of progress has allowed us to understand and intervene in human physiology at the tissue and organ level as never before, with breakthroughs in nanotechnology, sequencing, imaging, omics approaches, and other areas. These technologies can be used to build on proofs of principle for organ cryopreservation 6,7,25–28 , discoveries from organisms that can enter ‘suspended animation’ at subzero temperatures 29–32 , rapid advances in perfusion technologies 33–41 , and other advances.…”

Short, Cool, and Well Oxygenated – HOPE for Kidney Transplantation in a Rodent Model

“…HOPE was performed for 1 hour through the renal artery (aortic patch) with a constant perfusion pressure of <18 mm Hg, 20 and active oxygenation ( pO 2 60 to 80 kPa). We used 50 mL recirculating Kidney-Perfusion Solution-1 (KPS-1) as perfusate.…”

Organ preservation review

“…When comparing standard static cold storage in kidneys vs. use of HMP for preservation, studies have shown the HMP group kidneys to have a lower incidence of delayed graft function, although there remains controversy regarding long-term graft survival and patient survival rates [39][40][41][42][43][44]. When comparing standard static cold storage in kidneys vs. use of HMP for preservation, studies have shown the HMP group kidneys to have a lower incidence of delayed graft function, although there remains controversy regarding long-term graft survival and patient survival rates [39][40][41][42][43][44].…”