Experience With Hypothermic Machine Perfusion in Expanded Criteria Donors: Functional Outcomes

Area of Science:

• Nephrology
• Transplantation Surgery
• Organ Preservation

Background:

• Hypothermic machine perfusion (HMP) is a technique used to preserve donor organs.
• Expanded criteria donor (ECD) kidneys are associated with higher risks of delayed graft function (DGF) and poorer graft survival.
• The duration and method of HMP may influence outcomes in ECD kidney transplantation.

Purpose of the Study:

• To compare the functional outcomes of ECD kidneys preserved entirely with HMP (local grafts) versus those preserved with a combination of cold storage and HMP (imported grafts).

Main Methods:

• A prospective cohort study analyzed data from 193 first-time ECD kidney transplant recipients.
• Kidneys were categorized as local (fully preserved with HMP) or imported (preserved with cold storage and HMP).
• Outcomes assessed included DGF, acute rejection, vascular thrombosis, 1-year graft survival, and 1-year glomerular filtration rate.

Main Results:

• While not statistically significant, local ECD grafts showed a trend towards lower DGF rates (18.1%) compared to imported grafts (28.0%).
• One-year graft survival was significantly better for local ECD grafts (91.9%) compared to imported grafts (80.3%).
• No significant differences were observed in vascular thrombosis, acute rejection, or 1-year GFR between the groups.

Conclusions:

• Complete HMP for ECD kidneys demonstrates a trend in reducing DGF and improving 1-year graft survival.
• These findings suggest potential benefits of utilizing HMP for the entirety of the preservation period for ECD kidneys.
• Further investigation is warranted to solidify the role of HMP in optimizing outcomes for ECD kidney transplantation.