Machine perfusion: initial results in an expanded criteria donor kidney transplant program

Area of Science:

• Nephrology
• Transplantation immunology
• Organ preservation

Background:

• Delayed graft function (DGF) is a significant complication after kidney transplantation, particularly with expanded criteria donor (ECD) organs.
• Hypothermic machine perfusion (HMP) is a technique used to preserve kidneys, showing promise in reducing DGF and improving 1-year graft survival.
• Renal resistance (RR) during HMP has been suggested as a predictor of DGF and poorer graft survival.

Purpose of the Study:

• To evaluate the effectiveness of HMP in an ECD program.
• To assess the impact of donor parameters and resistance index (RI) during HMP on graft survival.
• To analyze HMP outcomes in the context of ECD kidney transplantation.

Main Methods:

• Donor age, terminal creatinine, perfusion time, glomerulosclerosis percentage, and RI were analyzed as risk predictors.
• Univariate and multivariate Cox regression models were used to identify independent risk factors for DGF.
• Diagnostic validity of RR for DGF was assessed using sensitivity, specificity, and predictive values.

Main Results:

• The incidence of DGF in the cohort was 23.3%, a reduction compared to historical data (38.0%).
• Flow and RI showed no significant difference in predicting DGF.
• The predictive accuracy of RI for DGF was poor (c-statistic = 0.66).
• No pretransplant risk factors were identified for predicting 1-year graft survival.
• Overall patient and graft survival rates were high (98.8% and 89.7%, respectively).

Conclusions:

• HMP effectively reduced DGF rates in recipients of ECD grafts.
• Renal resistance during HMP was not found to be a reliable predictor of DGF or graft survival in this cohort.
• Further research is needed to identify reliable pretransplant predictors for graft survival in ECD kidney transplantation.