The benefits of hypothermic machine preservation and short cold ischemia times in deceased donor kidneys

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 analysed prospectively collected data from the Machine Preservation Trial, an international randomized controlled trial. 752 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 15:05 hours (SD 4:58 hours). A subgroup analysis was performed, groups were based on CIT duration: 0-10 hours, 10-15 hours, 15-20 hours, or 20 hours and more. 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 OR 0.02, p=0.007). CIT remained an independent risk factor for DGF for machine perfused kidneys recovered from DBD donors OR 1.06, 95% CI 1.017-1.117, p=0.008), DCD donors (OR 1.13, 95% CI 1.035-1.233, p=0.006) and ECD donors (OR 1.14, 95% CI 1.057-1.236, p=0.001). Conclusion 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. Correspondence Information: Address: Maastricht University Medical Center, Jasper Kox, 2.G1.027, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: j.kox@maastrichtuniversity.nl Clinical trial notation ISRCTN83876362 Authorship Authorship statement Kox JJHFM: Writing of the paper, participated in data analysis Moers C: Writing of the paper, participated in data analysis, participated in research design, participated in performance of the research Monbaliu D: Participated in research design, participated in performance of the research, participated in paper revision Strelniece A: Participated in data analysis, participated in paper revision Treckmann J: Participated in research design, participated in performance of the research, participated in paper revision Jochmans I: Participated in research design, participated in performance of the research, participated in paper revision Leuvenink HGD: Participated in research design, participated in performance of the research, participated in paper revision Van Heurn LWE: Participated in research design, participated in performance of the research, participated in paper revision Pirenne J: Participated in research design, participated in performance of the research, participated in paper revision Paul A: Participated in research design, participated in performance of the research, participated in paper revision Ploeg RJ: Participated in research design, participated in performance of the research, participated in paper revision Disclosures The authors declare that they have no conflicts of interest relevant for the present study. Funding The clinical study on which the current analyses are based was financially supported by Organ Recovery Systems, Itasca, IL, USA. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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