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Updated: Feb 14, 2026
Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment
Published on: May 10, 2022
Perfusion Parameters of Donation After Cardiac Death Kidneys Predict Early Transplant Outcomes Based on Expanded
1Department of Renal Transplantation, Center of Nephropathy, The First Affiliated Hospital, Medical College of Xi'an Jiaotong University, Xi'an City, People's Republic of China.
Insights
Hypothermic machine perfusion parameters, particularly terminal resistance, significantly predict early transplant outcomes for kidneys from expanded criteria donors (ECD). These findings aid in evaluating donor kidney quality for improved graft survival.
Area of Science:
- Nephrology
- Transplant Surgery
- Organ Preservation
Background:
- Donation after cardiac death (DCD) is the sole source of deceased donors in China.
- Hypothermic machine perfusion (HMP) is increasingly utilized for organ preservation.
- This study investigates HMP parameters for predicting early transplant outcomes in DCD kidneys, focusing on expanded criteria donors (ECD).
Purpose of the Study:
- To identify hypothermic machine perfusion parameters associated with early transplant outcomes.
- To evaluate the predictive value of HMP parameters for delayed graft function (DGF) in DCD kidneys.
- To assess the utility of HMP parameters in conjunction with ECD designation.
Main Methods:
- Analysis of 446 consecutive DCD kidneys preserved with HMP (LifePort).
- Comparison of ECD and non-ECD groups.
- Logistic regression analysis to identify significant predictors of DGF, including LifePort parameters and pretransplant factors.
Main Results:
- DGF rates were higher in the ECD group (20.25%) compared to the non-ECD group (11.72%).
- Terminal resistance was the most significant predictor of DGF (OR 2.44, P < .001).
- A predictive model incorporating terminal resistance, hypotension, creatinine, and cause of death demonstrated good predictive ability (c-statistic 0.851).
Conclusions:
- LifePort HMP parameters offer granular insights into DCD kidney quality.
- HMP parameters provide valuable information beyond ECD designation for predicting transplant outcomes.
- These findings can enhance donor kidney selection and improve early graft function.
Background:
Donation after cardiac death is the only source of the deceased donor in China at present. Hypothermic machine perfusion has been used increasingly over the years. We determined the hypothermic machine perfusion parameters associated with early transplant outcomes based on the expanded criteria donor (ECD) designation.
Methods:
There were 446 consecutive kidneys donated after cardiac death and preserved by hypothermic machine perfusion (LifePort) in our center that were included in this study. The database was divided into 2 groups: ECD and non-ECD groups. LifePort parameters and other pretransplant factors were analyzed. Logistic regression analysis was used to determine the significant factors for delayed graft function (DGF). Recovery time for renal function and 6-months serum creatinine were investigated.
Results:
The DGF rates were 20.25% and 11.72% in ECD and non-ECD group by our definition, respectively (P = .042). Higher pressures allowed comparable increases of flow in ECD kidneys despite still greater resistance. For non-ECD kidneys with an initial flow of ≤80 mL/min, the DGF rate of the subgroup with a terminal flow of ≥100 mL/min was significantly lower compared with that of other terminal flow subgroups (≤80 and 90-100 mL/min; P < .05), and showed a trend toward significance when compared with the terminal flow subgroup of 80 to 90 mL/min (P = .098). Terminal resistance was the most significant parameter predicting DGF (odds ratio 2.44; P < .001), and remained significant after adjusted for other relevant pretransplant variables. Logistic model for DGF (model: terminal resistance, hypotension in agonal phase, terminal serum creatinine, and cause of death) had good predictive ability (c-statistic 0.851; 95% confidence interval, 0.799-0.903).
Conclusions:
LifePort parameters provided a granular measurement easily accessible in evaluating the quality of kidneys donated after cardiac death that added information to ECD criterion.
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