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Updated: Jul 24, 2025
Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
Outcomes After Deceased Donor Kidney Transplantation Using Kidney Allografts With Marginal Perfusion Parameters
Pranit N Chotai1, April Logan1, Jayanthan Subramanian1
1Division of Abdominal Transplantation, The Comprehensive Transplant Center, Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Background:
This study examines outcomes of deceased donor kidney transplantation (DDKT) in recipients of kidney allografts with marginal perfusion parameters.
Methods:
Allografts with marginal perfusion parameters (resistance index [RI] >0.4 and pump flow rate [F] <70 mL/min; MP group) were compared with those with good parameters (RI <0.4 and F >70 mL/min; GP group) for DDKT recipients between January 1996 and November 2017 after hypothermic pulsatile perfusion. Demographics, creatinine, cold ischemia times (CIT), delayed graft function (DGF), and recipient glomerular filtration rate at pre- and post-transplant were noted. The primary outcome was graft survival post-transplant.
Results:
In the MP (n = 31) versus GP (n = 1281) group, the median recipient was aged 57 years versus 51 years; the median donor was aged 47 versus 37 years; terminal creatinine was 0.9 versus 0.9 mg/dL; CIT was 10.2 versus 13 hours, and the RI and flow were 0.46 and 60 mL/min versus 0.21 and 120 mL/min. The DGF rate was 19% (MP) versus 8% (GP). The graft survival in the MP versus GP group was 81% versus 90% (1 year), 65% versus 79% (3 years), 65% versus 73% (4 years), and 45% versus 68% (5 years).
Conclusion:
Carefully selected kidney allografts after comprehensive donor and recipient evaluation may allow for the use of these routinely discarded kidneys with marginal perfusion parameters.
Insights
Kidney transplants using marginal perfusion allografts show reduced graft survival compared to good perfusion allografts. Careful selection may enable the use of these marginal kidneys in deceased donor kidney transplantation (DDKT).
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.
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01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure