Randomized Trial of Machine Perfusion Versus Cold Storage in Recipients of Deceased Donor Kidney Transplants With High Incidence of Delayed Graft Function

Abstract

BackgroundThis study compared the use of static cold storage versus continuous hypothermic machine perfusion in a cohort of kidney transplant recipients at high risk for delayed graft function (DGF).MethodsIn this national, multicenter, and controlled trial, 80 pairs of kidneys recovered from brain-dead deceased donors were randomized to cold storage or machine perfusion, transplanted, and followed up for 12 months. The primary endpoint was the incidence of DGF. Secondary endpoints included the duration of DGF, hospital stay, primary nonfunction, estimated glomerular filtration rate, acute rejection, and allograft and patient survivals.ResultsMean cold ischemia time was high but not different between the 2 groups (25.6 ± 6.6 hours vs 25.05 ± 6.3 hours, 0.937). The incidence of DGF was lower in the machine perfusion compared with cold storage group (61% vs. 45%, P = 0.031). Machine perfusion was independently associated with a reduced risk of DGF (odds ratio, 0.49; 95% confidence interval, 0.26-0.95). Mean estimated glomerular filtration rate tended to be higher at day 28 (40.6 ± 19.9 mL/min per 1.73 m2 vs 49.0 ± 26.9 mL/min per 1.73 m2; P = 0.262) and 1 year (48.3 ± 19.8 mL/min per 1.73 m2 vs 54.4 ± 28.6 mL/min per 1.73 m2; P = 0.201) in the machine perfusion group. No differences in the incidence of acute rejection, primary nonfunction (0% vs 2.5%), graft loss (7.5% vs 10%), or death (8.8% vs 6.3%) were observed.ConclusionsIn this cohort of recipients of deceased donor kidneys with high mean cold ischemia time and high incidence of DGF, the use of continuous machine perfusion was associated with a reduced risk of DGF compared with the traditional cold storage preservation method.

Factors predicting kidney delayed graft function among recipients of simultaneous liver‐kidney transplantation: A single‐center experience

“…Many of these factors agree with previously published reports assessing risk factors for kDGF. 13,17,21,22,42–45 With regard to donors with history of hypertension, we found that they belonged to an older group of donors with median age of 49 years (IQR = 40–56), versus donors without a history of hypertension (median age: 29 years, IQR = 21–43). We used the duration of delay between kidney and liver transplantation as a surrogate for kidney CIT in the multivariate analysis since it is easier to determine prior to implantation of the kidney as our intention is to evaluate preoperative risk factors that would contribute to the development of kDGF.…”

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

“…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).…”

“…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).…”

“…DGF was defined as the need for dialysis within the first week after transplantation in 8 trials (12,13,(15)(16)(17)20,22,24). DGF was defined as the need for dialysis within the first week after transplantation in 8 trials (12,13,(15)(16)(17)20,22,24).…”

“…Two RCTs found a significantly lower serum creatinine level with hypothermic machine perfusion than static cold storage at one week after transplantation (15,24), and similar results were observed at two weeks (13,24). Due to inconsistent observation time, a meta-analysis was not performed for this endpoint.…”