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Updated: Mar 10, 2026
Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
Ex Vivo Perfusion Characteristics of Donation After Cardiac Death Kidneys Predict Long-Term Graft Survival
Insights
A low Perfusion Flow Index (PFI) during ex vivo kidney perfusion predicts poorer long-term graft survival in donation after cardiac death transplants. PFI is a key indicator of vascular health and transplant success.
Area of Science:
- Nephrology
- Transplantation Surgery
- Vascular Biology
Background:
- Ex vivo hypothermic perfusion is utilized for kidneys from donors after cardiac death (DCD).
- Perfusion parameters like Perfusion Flow Index (PFI), resistance, and perfusate glutathione S-transferase (GST) assess graft viability.
- The study aimed to determine if these perfusion parameters predict long-term transplant outcomes.
Purpose of the Study:
- To evaluate the predictive value of ex vivo machine perfusion parameters for long-term graft survival in DCD kidney transplantation.
- To identify key indicators of graft viability and predict post-transplant outcomes.
Main Methods:
- Retrospective analysis of 155 DCD kidney transplants performed between 2002 and 2014.
- Exclusion of incomplete data, non-machine perfused kidneys, continuous perfusion modes, and dual transplants.
- Analysis of demographic data, ischemia times, donor hypertension, graft function, survival, and machine perfusion parameters (PFI, GST) after 3 hours.
Main Results:
- A significant association was found between graft survival and both PFI and GST (P=.020 and P=.022).
- Perfusion Flow Index (PFI) emerged as the sole independent predictor of graft survival.
- Low PFI during perfusion correlated with inferior long-term graft survival.
Conclusions:
- Low Perfusion Flow Index (PFI) during ex vivo hypothermic perfusion is linked to reduced graft survival in DCD kidney transplantation.
- PFI is proposed as a valuable measure of graft vasculature health.
- A low PFI suggests underlying vascular disease, predicting a less favorable long-term transplant outcome.
Background:
Ex vivo perfusion is used in our unit for kidneys donated after cardiac death (DCD). Perfusion flow index (PFI), resistance, and perfusate glutathione S-transferase (GST) can be measured to assess graft viability. We assessed whether measurements taken during perfusion could predict long-term outcome after transplantation.
Methods:
All DCD kidney transplants performed from 2002 to 2014 were included in this study. The exclusion criteria were: incomplete data, kidneys not machine perfused, kidneys perfused in continuous mode, and dual transplantation. There were 155 kidney transplantations included in the final analysis. Demographic data, ischemia times, donor hypertension, graft function, survival and machine perfusion parameters after 3 hours were analyzed. Each perfusion parameter was divided into 3 groups as high, medium, and low. Estimated glomerular filtration rate was calculated at 12 months and then yearly after transplantation.
Results:
There was a significant association between graft survival and PFI and GST (P values, .020 and .022, respectively). PFI was the only independent parameter to predict graft survival.
Conclusions:
A low PFI during ex vivo hypothermic perfusion is associated with inferior graft survival after DCD kidney transplantation. We propose that PFI is a measure of the health of the graft vasculature and that a low PFI indicates vascular disease and therefore predicts a worse long-term outcome.
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