Decrease of renal resistance during hypothermic oxygenated machine perfusion is associated with early allograft...

Area of Science:

• Nephrology and Transplant Surgery
• Organ Preservation and Perfusion Technologies

Background:

• Hypothermic oxygenated machine perfusion (HOPE) is a novel organ preservation technique tested in preclinical kidney transplantation (KT) models.
• Extended criteria donor (ECD) kidney allografts (KA) are associated with higher risks of delayed graft function (DGF) and poorer outcomes.
• Evaluating HOPE's efficacy in preserving ECD-KA compared to conventional cold storage (CCS) is crucial for improving transplant success rates.

Purpose of the Study:

• To investigate the clinical effects of HOPE on ECD-KA compared to CCS.
• To analyze the impact of HOPE on primary endpoints like DGF and secondary endpoints including postoperative complications and perfusion parameters.
• To explore the potential of perfusion parameters, such as relative decrease in renal vascular resistance (RR), as predictive markers for kidney allograft function.

Main Methods:

• Fifteen ECD-KA underwent end-ischemic HOPE for 152 ± 92 minutes.
• A matched control group of 30 ECD-KA received conventional cold storage (CCS).
• Outcomes including DGF, serum creatinine, urea, estimated glomerular filtration rate (eGFR), and perfusion parameters were assessed up to 6 months post-transplant.

Main Results:

• No significant difference in DGF rates was observed between HOPE (53%) and CCS (33%) groups (p=0.197).
• HOPE group showed lower serum urea (p=0.003), while CCS group had lower serum creatinine and higher eGFR on postoperative days 7 and 14.
• A significant inverse association was found between relative RR decrease and serum creatinine/urea, and eGFR on postoperative day 1 (p<0.01). Relative RR decrease was more pronounced in grafts with primary function compared to those with DGF (p=0.013).

Conclusions:

• This study provides clinical evidence for HOPE in ECD-KT from brain-dead donors, indicating potential benefits beyond DGF reduction.
• Relative decrease in renal vascular resistance during HOPE may serve as a valuable predictive marker for early kidney allograft function.
• Further validation of HOPE in randomized controlled trials is warranted to confirm its efficacy and refine its application in kidney transplantation.