Cold machine perfusion versus static cold storage of kidneys donated after cardiac death: a UK multicenter randomized...

Area of Science:

• Nephrology
• Transplantation immunology
• Organ preservation

Background:

• Deceased donor kidneys following cardiac death (DCD) are crucial for transplantation in the UK, accounting for one-third of all deceased donor kidneys.
• Kidneys from DCD donors are associated with a higher incidence of delayed graft function (DGF) post-transplant.
• Optimizing preservation techniques for DCD kidneys is essential to improve transplant outcomes.

Purpose of the Study:

• To compare the efficacy of cold, pulsatile machine perfusion (MP) versus simple cold storage (CS) for preserving DCD kidneys.
• To determine if MP reduces the rate of delayed graft function (DGF) in DCD kidney transplants.
• To evaluate the impact of MP versus CS on renal function and graft survival at 3 and 12 months.

Main Methods:

• A multicenter, randomized controlled trial was conducted, allocating one kidney from each DCD donor to either MP or CS.
• The primary endpoint was DGF, defined as the need for dialysis within 7 days post-transplant.
• The trial utilized a sequential design and was stopped after analyzing 45 pairs of kidneys.

Main Results:

• No significant difference in the incidence of DGF was observed between MP (58%) and CS (56%) groups.
• Renal function at 3 and 12 months post-transplant was similar for both preservation methods.
• Graft and patient survival rates were comparable between the MP and CS groups.

Conclusions:

• For controlled DCD kidneys with cold ischemic times around 14 hours, machine perfusion (MP) offers no discernible advantage over simple cold storage (CS).
• Simple cold storage (CS) remains a cost-effective and straightforward preservation method for DCD kidneys.
• Further research may be needed to identify specific DCD donor subsets who might benefit from machine perfusion.