A Comprehensive Analysis on the Impact of Hypothermic Machine Perfusion and its Influence on Delayed Graft Function

Area of Science:

• Nephrology
• Transplantation Surgery
• Medical Engineering

Background:

• Delayed graft function (DGF) complicates deceased-donor kidney transplantation, increasing patient morbidity and healthcare costs.
• Hypothermic machine perfusion (HMP) is a potential strategy to mitigate DGF, but large-scale real-world data are limited.

Purpose of the Study:

• To evaluate the effectiveness of HMP versus static cold storage (SCS) in reducing DGF using real-world data.
• To identify modifiable risk factors associated with DGF in kidney transplantation.

Main Methods:

• Retrospective cohort analysis of adult kidney transplant recipients from the Scientific Registry of Transplant Recipients (2014-2024).
• Comparison of DGF rates between kidneys preserved with SCS and HMP, including a matched-pairs analysis using kidneys from the same donor.
• Primary outcome: DGF, defined as the need for dialysis within 7 days post-transplant.

Main Results:

• In the overall cohort (59,859 recipients), HMP grafts had higher DGF rates (34.4% vs. 30.9%).
• However, matched-pairs analysis (2208 pairs) revealed significantly lower DGF rates with HMP (29.8% vs. 36.1%).
• Adjusted analyses confirmed HMP as protective against DGF (OR 0.71 overall, 0.68 paired). Prolonged cold ischemia time, higher BMI, and longer dialysis duration were also risk factors.

Conclusions:

• Real-world data demonstrate HMP significantly reduces the risk of DGF in kidney transplantation compared to SCS.
• These findings support the broader implementation of HMP.
• Targeted management of modifiable risk factors like cold ischemia time is crucial.