Related Experiment Video
Updated: Jan 21, 2026
Large-Animal Model of Donation after Circulatory Death and Normothermic Regional Perfusion for Cardiac Assessment
Published on: May 10, 2022
Cold Pulsatile Machine Perfusion Versus Static Cold Storage for Kidneys Donated After Circulatory Death: A
Dominic M Summers1,2,3,4, Niaz Ahmad5,6, Lucy V Randle1
1Department of Surgery, University of Cambridge, Cambridge, United Kingdom.
Background:
The benefits of cold pulsatile machine perfusion (MP) for the storage and transportation of kidneys donated after circulatory death are disputed. We conducted a UK-based multicenter, randomized controlled trial to compare outcomes of kidneys stored with MP versus static cold storage (CS).
Methods:
Fifty-one pairs of kidneys donated after circulatory death were randomly allocated to receive static CS or cold pulsatile MP. The primary endpoint, delayed graft function, was analyzed by "intention-to-treat" evaluation.
Results:
There was no difference in the incidence of delayed graft function between CS and MP (32/51 (62.8%) and 30/51 (58.8%) P = 0.69, respectively), although the trial stopped early due to difficulty with recruitment. There was no difference in the incidence of acute rejection, or in graft or patient survival between the CS and MP groups. Median estimated glomerular filtration rate at 3 months following transplantation was significantly lower in the CS group compared with MP (CS 34 mL/min IQR 26-44 vs MP 45 mL/min IQR 36-60, P = 0.006), although there was no significant difference in estimated glomerular filtration rate between CS and MP at 12 months posttransplant.
Conclusions:
This study is underpowered, which limits definitive conclusions about the use of MP, as an alternative to static CS. It did not demonstrate that the use of MP reduces the incidence of delayed graft function in donation after circulatory death kidney transplantation.
Insights
Cold pulsatile machine perfusion (MP) did not show benefits over static cold storage (CS) for kidney transplants from circulatory death donors. The study was underpowered, but found no significant difference in delayed graft function.
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.
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