Introduction

Hypothermic machine perfusion (HMP) of deceased donor kidneys is associated with better outcome compared to static cold storage (SCS). It is generally assumed that HMP will only improve results for kidneys with a substantial degree of ischemic injury. Many transplant clinicians believe that renal grafts with a short cold ischemic time (CIT) will benefit little from HMP. Also, it is often presumed that kidneys are safe during HMP and the duration of cold ischemia is less relevant while renal grafts are on the machine. Aim of our study was to investigate whether HMP also results in a lower incidence of delayed graft function (DGF) compared to SCS for kidneys that are transplanted with a maximum of 10 hrs of cold ischemia and to test whether CIT remains an independent risk factor for DGF when kidneys are machine perfused.

Methods

We analysed data that has been prospectively collected in the Machine Preservation Trial. In this international RCT, HMP was compared to SCS of deceased donor kidneys. A total of 376 consecutive kidney donors were included, of whom one kidney was machine perfused and the other kidney was preserved by SCS. A post hoc multivariable data analysis was performed to investigate the effect of HMP versus SCS on renal grafts with a short (up to 10 hrs) CIT and to quantify the influence of CIT on the risk of DGF when kidneys are machine perfused.

Results

In this cohort, the mean CIT was 15 hrs 5 min (SD 4 hrs 58 min), the DGF incidence was 27.9%. DGF incidence in the sub group with up to 10 hrs CIT was 6.0% in the HMP arm and 28.1% in the CS arm (univariable P=0.002, multivariable OR 0.02, P=0.007). Three year graft survival in the <10 hrs CIT group did not differ significantly between study arms (88.0% for HMP and 81.2% for SCS, P=0.308). CIT remained an independent risk factor for DGF for all machine perfused kidneys recovered from DBD donors (OR =1.07, P=0.008), DCD donors (OR = 1.13, P=0.006) and ECD donors (OR = 1.14, P=0.001).

Conclusion

HMP results in lower rates of DGF than SCS in kidney transplantation. The current analysis shows that, contrary to popular belief, this is also true for renal grafts that are transplanted after a short CIT. In addition, our data suggests that CIT remains a relevant and independent risk factor for DGF in HMP-preserved kidneys.

CITATION INFORMATION: Kox J, Moers C, Monbaliu D, Strelniece A, Treckmann J.-W, Jochmans I, Leuvenink H, van Heurn L, Pirenne J, Paul A, Ploeg R. Hypothermic Machine Perfusion Is Also Beneficial for Deceased Donor Kidneys When Cold Ischemic Time Is Short and a Short Cold Ischemic Time Is Also Beneficial When Kidneys Are Machine Perfused. Am J Transplant. 2016;16 (suppl 3).

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