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Updated: Jul 19, 2026
Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
Mechanical Preservation and Delayed Graft Function and Hospital Length of Stay as Deployed in the United States:
Douglas S Keith1, Elizabeth Lessmann1
1Ascension Sacred Heart Kidney Transplant Program, Ascension Sacred Heart Hospital, Pensacola, FL, USA.
Abstract:
BACKGROUND Mechanical preservation (MP) of deceased donor kidney transplants showed a 30% to 50% reduction in delayed graft function (DGF) as defined by dialysis in the first week, when compared with cold storage. DGF is associated with longer hospital stays and increased costs. In this study, we sought to understand the impact of MP on rates of DGF and length of hospital stays in a contemporary cohort of deceased donor kidney transplants in the United States. MATERIAL AND METHODS All single deceased donor kidney transplants performed between January 1, 2010, and September 2, 2020, were identified in the Scientific Registry of Transplant Recipients database. Donor kidneys were considered pumped if the transplant center received the kidney on the pump. RESULTS Multivariate logistic regression showed that MP had similar odds of reduction of DGF for all subsets of donors. The unadjusted rate of DGF for pumped brain-dead standard criteria donor (BDSCD) recipients was similar to that of donors stored on ice. The rate of DGF for expanded criteria donors (ECD) and donors after cardiac death (DCD) was lower in the recipients who received MP. The similar DGF rates in BDSCD donor recipients were due to longer cold ischemia times in MP kidneys. The lower DGF rates seen in ECD and DCD recipients of pumped kidneys did not translate into a shortened length of hospitalization after transplant. CONCLUSIONS As currently deployed, only DCD and ECD donor recipients of MP kidneys experienced a lower DGF rate. In all subsets of patients, MP did not appreciably shorten the hospital length of stay.
Insights
Mechanical preservation (MP) of deceased donor kidneys reduced delayed graft function (DGF) in expanded criteria donor (ECD) and donor after cardiac death (DCD) recipients. However, MP did not shorten hospital stays for any patient group.
Area of Science:
- Nephrology
- Transplant Surgery
- Organ Preservation
Background:
- Mechanical preservation (MP) of deceased donor kidneys shows promise in reducing delayed graft function (DGF) compared to traditional cold storage.
- DGF is linked to extended hospital stays and increased healthcare costs, highlighting the need for improved preservation methods.
- This study investigates the contemporary impact of MP on DGF rates and hospitalization duration in deceased donor kidney transplants within the U.S.
Purpose of the Study:
- To evaluate the effectiveness of mechanical preservation (MP) in reducing delayed graft function (DGF) after deceased donor kidney transplantation.
- To assess the impact of MP on hospital length of stay across different donor types.
- To analyze contemporary U.S. data on MP for kidney transplants.
Main Methods:
- Utilized the Scientific Registry of Transplant Recipients database for single deceased donor kidney transplants from January 1, 2010, to September 2, 2020.
- Identified kidneys as mechanically preserved if received by the transplant center via a pump system.
- Employed multivariate logistic regression to analyze DGF rates and hospital stay duration.
Main Results:
- MP demonstrated similar DGF reduction odds across all donor subsets.
- Unadjusted DGF rates were comparable between MP and cold storage for brain-dead standard criteria donors (BDSCD).
- MP was associated with lower DGF rates in expanded criteria donors (ECD) and donors after cardiac death (DCD), though this did not shorten hospital stays.
Conclusions:
- Only recipients of ECD and DCD donor kidneys preserved with MP experienced a significant reduction in DGF.
- Mechanical preservation, as currently implemented, did not lead to a shorter hospital length of stay for any patient group.
- Further research may be needed to optimize MP protocols for broader DGF reduction and improved patient outcomes.
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