Comparison of intracellular flushing and cold storage to machine perfusion for human kidney preservation

Transplant teams have been reluctant to accept kidneys preserved with intracellular electrolyte flushing followed by simple cold storage, especially when retrieved by non-transplant surgeons or when preservation time exceeds 24 hours. This study from 1 center is a comparison of 40 primary cadaver kidney grafts preserved with Collins' C2 flushing followed by simple cold storage to 37 primary cadaver kidney grafts preserved with cryoprecipitated plasma on the MOX-100 machine. Cold storage time was 10 to 44.5 hours in the C2 group and 3.5 to 39 hours in the machine-perfused group, with a mean of 23 hours in each group. There was no significant difference between the 2 preservation methods no matter who removed the kidney with respect to 1) the incidence of acute tubular necrosis, 2) the 1-month serum creatinine nadir of surviving grafts and 3) the actuarial graft survivals up to 2 years. Among the 40 C2-preserved kidneys 17 were retrieved by community surgeons and 23 were retrieved by transplant surgeons. Human kidneys removed from beating-heart cadaver donors can be preserved satisfactorily with either Collins' 2 flushing followed by simple cold storage or pulsatile machine perfusion, even when preservation times exceed 24 hours.