Hypothermic Machine Perfusion as a National Standard Preservation Method for Deceased Donor Kidneys

Background. Recently, continuous nonoxygenated hypothermic machine perfusion (HMP) has been implemented as standard preservation method for deceased donor kidneys in the Netherlands. This study was designed to assess the effect of the implementation of HMP on early outcomes after transplantation. Methods. Kidneys donated in the Netherlands in 2016 and 2017 were intended to be preserved by HMP. A historical cohort (2010–2014) preserved by static cold storage was chosen as the control group. Primary outcome was delayed graft function (DGF). Additional analyses were performed on safety, graft function, and survival up until 2 y after transplantation. Results. Data were collected on 2493 kidneys. Analyses showed significantly more donation after circulatory death, preemptive transplantation, and retransplants in the project cohort. Of the 681 kidneys that were transplanted during the project, 81% were preserved by HMP. No kidneys were discarded due to HMP-related complications. DGF occurred in 38.2% of the project cohort versus 43.7% of the historical cohort (P < 0.001), with a significantly shorter duration within the project cohort (7 versus 9 d, P = 0.003). Multivariate regression analysis showed an odds ratio of 0.69 (95% confidence interval, 0.553-0.855) for the risk of DGF when using HMP compared with cold storage (P = 0.001). There was no significant difference in kidney function, graft survival, and recipient survival up until 2 y posttransplantation. Conclusions. This study showed that HMP as a standard preservation method for deceased donor kidneys is safe and feasible. HMP was associated with a significant reduction of DGF.

[1]  D. Abramowicz,et al.  Oxygenated versus standard cold perfusion preservation in kidney transplantation (COMPARE): a randomised, double-blind, paired, phase 3 trial , 2020, The Lancet.

[2]  B. Kasiske,et al.  The economic burden of kidney graft failure in the United States , 2020, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[3]  J. J. Homan van der Heide,et al.  Impact of Cold Ischemia Time on Outcomes of Deceased Donor Kidney Transplantation: An Analysis of a National Registry , 2019, Transplantation direct.

[4]  Colin H. Wilson,et al.  Machine perfusion preservation versus static cold storage for deceased donor kidney transplantation. , 2019, The Cochrane database of systematic reviews.

[5]  R. Ploeg,et al.  The Benefits of Hypothermic Machine Preservation and Short Cold Ischemia Times in Deceased Donor Kidneys , 2018, Transplantation.

[6]  A. Chandraker,et al.  The Lifetime Health Burden of Delayed Graft Function in Kidney Transplant Recipients in the United States , 2018, MDM policy & practice.

[7]  M. Stegall,et al.  Reassessing Preemptive Kidney Transplantation in the United States: Are We Making Progress? , 2016, Transplantation.

[8]  A. Rahmel,et al.  Cost‐Effectiveness of Hypothermic Machine Preservation Versus Static Cold Storage in Renal Transplantation , 2012, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[9]  R. Ploeg,et al.  Machine perfusion or cold storage in deceased-donor kidney transplantation. , 2009, The New England journal of medicine.

[10]  J. Ringers,et al.  Kidneys from donors after cardiac death provide survival benefit. , 2010, Journal of the American Society of Nephrology : JASN.

[11]  R. Formica,et al.  Association between delayed graft function and allograft and patient survival: a systematic review and meta-analysis. , 2008, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[12]  L. Pączek,et al.  The early and long term function and survival of kidney allografts stored before transplantation by hypothermic pulsatile perfusion. A prospective randomized study. , 2009, Annals of transplantation.

[13]  F. Port,et al.  Effect of waiting time on renal transplant outcome. , 2000, Kidney international.

[14]  Eld,et al.  COMPARISON OF MORTALITY IN ALL PATIENTS ON DIALYSIS , PATIENTS ON DIALYSIS AWAITING TRANSPLANTATION , AND RECIPIENTS OF A FIRST CADAVERIC TRANSPLANT , 2000 .

[15]  P. Terasaki,et al.  ADVANTAGE OF COLD STORAGE OVER MACHINE PERFUSION FOR PRESERVATION OF CADAVER KIDNEYS , 1982, Transplantation.

[16]  M. R. Mickey,et al.  Evaluation of Belzer and Collins kidney-preservation methods. , 1973, Lancet.

[17]  F. Belzer.  Current methods of kidney storage. , 1969, Cryobiology.