Outcomes After Deceased Donor Kidney Transplantation Using Kidney Allografts With Marginal Perfusion Parameters

Area of Science:

• Nephrology
• Transplantation Surgery
• Organ Procurement

Background:

• Deceased donor kidney transplantation (DDKT) outcomes are examined.
• Focus on kidney allografts with marginal perfusion parameters.

Purpose of the Study:

• Compare outcomes of DDKT using marginal perfusion (MP) versus good perfusion (GP) allografts.
• Evaluate graft survival and associated factors.

Main Methods:

• Retrospective analysis of DDKT recipients from 1996-2017.
• MP group: resistance index (RI) >0.4 and pump flow rate (F) <70 mL/min.
• GP group: RI <0.4 and F >70 mL/min; hypothermic pulsatile perfusion used.

Main Results:

• MP group had higher delayed graft function (DGF) rates (19% vs 8%).
• Graft survival at 5 years was lower for MP (45%) vs GP (68%).
• MP recipients and donors were older on average.

Conclusions:

• Kidney allografts with marginal perfusion parameters demonstrate inferior graft survival post-DDKT.
• Careful donor and recipient evaluation may allow utilization of some marginal kidneys.
• Routine discard of marginal kidneys may be reconsidered with stringent selection criteria.