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The Benefits of Hypothermic Machine Preservation and Short Cold Ischemia Times in Deceased Donor Kidneys

Kox, Jasper, MD1; Moers, Cyril, MD, PhD2; Monbaliu, Diethard, MD, PhD3,4; Strelniece, Agita, MSc5; Treckmann, Jürgen, MD6; Jochmans, Ina, MD, PhD3,4; Leuvenink, Henri, PhD2; Van Heurn, Ernest, MD, PhD1; Pirenne, Jacques, MD, PhD3,4; Paul, Andreas, MD, PhD6; Ploeg, Rutger, MD, PhD2,7

doi: 10.1097/TP.0000000000002188
Original Clinical Science—General

Background Hypothermic machine perfusion (HMP) of deceased donor kidneys is associated with better outcome when compared to static cold storage (CS). Nevertheless, there is little evidence whether kidneys with short cold ischemia time (CIT) also benefit from HMP and whether HMP can safely extend CIT.

Methods We analyzed prospectively collected data from the Machine Preservation Trial, an international randomized controlled trial. Seven hundred fifty-two consecutive renal transplants were included: 1 kidney of each of the 376 donors was preserved by HMP, the contralateral organ was preserved by CS.

Results The mean CIT was 3:05 PM (SD, 4:58 AM). A subgroup analysis was performed, groups were based on CIT duration: 0 to 10 hours, 10 to 15 hours, 15 to 20 hours, or 20 hours or longer. Delayed graft function (DGF) incidence in the subgroup with up to 10 hours CIT was 6.0% (N = 3/50) in the HMP arm and 28.1% (N = 18/64) in the CS arm (univariable P = 0.002; multivariable odds ratio [OR], 0.02; P = 0.007). Cold ischemia time remained an independent risk factor for DGF for machine perfused kidneys recovered from donation after brain death donors (OR, 1.06; 95% confidence interval [CI], 1.017-1.117; P = 0.008), donation after circulatory death donors (OR, 1.13; 95% CI, 1.035-1.233; P = 0.006) and expanded criteria donors (OR, 1.14; 95% CI, 1.057-1.236; P = 0.001).

Conclusions In conclusion, HMP resulted in remarkably lower rates of DGF in renal grafts that were transplanted after a short CIT. Also, CIT remained an independent risk factor for DGF in HMP-preserved kidneys.

This analysis of an international randomized controlled trial data shows that the use of hypothermic machine perfusion was associated with lower incidence of delayed graft function only with short (< 10 hours) but not with longer cold ischemia times, although no difference in graft survival was observed.

1 Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.

2 Department of Surgery-Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

3 Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.

4 Abdominal Transplant Surgery Laboratory, Department of Microbiology and Immunology, University Hospitals Leuven, Leuven, Belgium.

5 Eurotransplant International Foundation, Leiden, Netherlands.

6 Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.

7 Nuffield Department of Surgical Sciences and Oxford Transplant Centre, University of Oxford and Oxford University Hospitals NHS Trust, Oxford, United Kingdom.

Received 8 September 2017. Revision received 28 December 2017.

Accepted 14 January 2018.

The clinical study on which the current analyses are based was financially supported by Organ Recovery Systems, Itasca, IL.

The authors declare no conflicts of interest.

J.K. participated in writing of the article and data analysis. C.M. participated in the writing of the article, data analysis, research design, and performance of the research. D.M. participated in research design, performance of the research, and article revision. A.S. participated in data analysis and article revision. J.T. participated in research design, performance of the research, and article revision. I.J. participated in research design, performance of the research, and article revision. H.L. participated in research design, performance of the research, and article revision. E.V.H. participated in research design, performance of the research, and article revision. J.P. participated in research design, performance of the research, article revision. A.P. participated in research design, performance of the research, and article revision. R.P. participated in research design, performance of the research, and article revision.

Clinical trial notation: ISRCTN83876362

Correspondence: Jasper Kox, MD, Maastricht University Medical Center, Jasper Kox, 2.G1.027, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. (j.kox@maastrichtuniversity.nl).

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