Clinical and Operational Evaluation of Hypothermic Machine Perfusion for Kidney Transplantation in a Brazilian...

Hypothermic machine perfusion (MP) improves outcomes in kidney transplantation, but evidence from low- and middle-income countries (LMICs) and public health settings is limited. This study evaluated clinical and operational performances of MP in the first and largest Brazilian renal perfusion service.

This single-center study was conducted at a Brazilian public hospital. Operational performance was evaluated through a qualitative observational analysis using a 20-item questionnaire applied to 7 transplant surgeons and perfusion nurses, based on national medical device assessment guidelines. Clinical outcomes were assessed in a longitudinal cohort of 212 deceased-donor kidney transplant recipients. Kidneys preserved with MP after an initial period of static cold storage (MP group, n = 100) were compared with those preserved exclusively with static cold storage (SCS group, n = 112). Outcomes included delayed graft function (DGF), dialysis requirement, length of hospital stay, and one-year graft and patient survival. Final data collection and analysis were completed in September 2025.

Operational evaluation was preponderantly favorable, supporting the sustainable use of MP, which was associated with a lower incidence of DGF compared with SCS (25% vs 46.5%; p = .002) and independently associated with lower odds of DGF (OR = 0,38; CI 95%: 0,21-0,69). MP recipients required fewer dialysis sessions and had shorter hospital stays. Graft function, rejection rates, and one-year graft and patient survival were similar between groups.

In a real-life LMIC public health setting, MP was operationally sustainable and reduced DGF after kidney transplantation, supporting its use in resource-constrained transplant programs.