Cold Pulsatile Machine Perfusion Versus Static Cold Storage for Kidneys Donated After Circulatory Death: A...

Area of Science:

• Nephrology
• Transplantation
• Organ Preservation

Background:

• The efficacy of cold pulsatile machine perfusion (MP) versus static cold storage (CS) for kidneys from donors after circulatory death (DCD) remains debated.
• A UK-based multicenter randomized controlled trial was conducted to compare these preservation methods.

Purpose of the Study:

• To compare the outcomes of kidney transplantation using cold pulsatile machine perfusion (MP) versus static cold storage (CS) for kidneys donated after circulatory death (DCD).

Main Methods:

• A randomized controlled trial involving 51 pairs of DCD kidneys allocated to either static CS or cold pulsatile MP.
• The primary endpoint was delayed graft function, analyzed using an intention-to-treat approach.

Main Results:

• No significant difference in delayed graft function incidence between CS and MP groups (62.8% vs 58.8%, P=0.69).
• No differences observed in acute rejection, graft survival, or patient survival.
• Median estimated glomerular filtration rate at 3 months was lower in the CS group (34 mL/min) compared to the MP group (45 mL/min), P=0.006, but this difference was not significant at 12 months.

Conclusions:

• The study is underpowered, limiting definitive conclusions on MP's utility over static CS for DCD kidneys.
• Machine perfusion did not demonstrate a reduction in delayed graft function incidence in this trial.