虚血時間延長腎移植における温冷体外灌流の比較：ランダム化比較試験

Hypothermic machine perfusion(HMP) is considered the gold standard in kidney preservation. Despite this, grafts from extended criteria donors(ECD-DBD) and donation after circulatory death(DCD) remain at high risk of delayed graft function(DGF). Normothermic machine perfusion(NMP) during the preservation process could alternatively preserve physiological activity. We investigated the value of additional NMP to HMP in ECD-DBD and DCD kidney transplantation. This is a single-centre, open-label, superiority, randomized controlled trial. Patients were randomized to receive a kidney that was either preserved on HMP and two hours of end-ischemic HMP+NMP(intervention group) or HMP only(control group). Primary outcome was the incidence of immediate graft function(IGF). A total of 80 patients were included in the intention-to-treat analysis, of which 41 received a kidney that was preserved on HMP and HMP+NMP and 39 received a graft that was preserved on HMP alone. Incidence of IGF was 16/41(39%) in HMP+NMP group compared to 19/39(49%) in the HMP group, with no significant difference between both groups(OR: 0.68, 95% CI: 0.28-1.64, p=0.38). There was no statistically significant difference in any of the secondary outcomes. The addition of two hours end-ischemic NMP does not improve early graft outcomes in kidney transplantation compared to HMP alone.