Pulsatile perfusion of kidney allografts

The purpose of this article is to describe the current use of pulsatile kidney perfusion during organ preservation and the effects on kidney allograft outcomes and utilization.

As of spring 2008, there were 75 629 candidates on the kidney waiting list in the USA according to United Network for Organ Sharing data. In 2006, a total of 1815 deceased donor expanded criteria donors kidneys were transplanted, and approximately 80% of those kidneys had cold ischemic time of over 12 h. The utilization of kidney pulsatile perfusion varies extensively throughout the USA with rates of 7-12% in our institution.

Data on the use of pulsatile hypothermic perfusion for kidneys during organ preservation are limited and mostly retrospective. Most authors agree that pulsatile perfusion is safe and leads to a decrease in delayed graft function, especially for marginal kidneys from extended criteria or deceased donors. The long-term effects of delayed graft function on graft survival remain to be seen. With the recent large-sampled international prospective randomized trial recently completed, we may see more kidneys pulsatile perfused. This may lead to an increase in the utilization of otherwise discarded kidneys, though these data are difficult to extrapolate.