Introduction:

Hypothermic machine perfusion (HMP) has been shown to be an effective method for preserving kidney allografts from deceased donors (1), but data suggests that low-risk donors may not benefit (2). The aims of our study were to examine the utilization of HMP in a real-world setting, as well as to examine its effect on clinical outcomes in high and low-risk donors.

Methods:

We conducted a retrospective cohort study of the Lifecenter Northwest organ procurement database from 2010-2015, linked to the United Network of Organ Sharing (UNOS) outcomes database. We used the Kidney Donor Profile Index (KDPI) to classify donor risk. Our primary outcomes were delayed graft function (DGF) and graft survival. Multivariable Poisson regression models analyzed factors associated with utilization of HMP, as well as the association of HMP utilization with DGF. Multivariable Cox proportional hazards regression models were used to analyze the association of HMP with graft survival.

Results:

During the study period, 2160 deceased-donor kidneys were procured, and 860 (39.8%) were preserved with hypothermic machine perfusion; outcome data for 1729 kidneys (80%) was available. The mean age of the donor cohort was 37.7 + 15.5 years. On multivariable analysis, higher donor age, higher donor BMI, region of procurement, the utilization of the KDPI score, and donation after cardiac death (DCD) criteria were associated with the use of hypothermic machine perfusion. The use of HMP was associated with decreased risk of DGF (p<0.0001). Among kidneys with an available KDPI score, there was a decreased risk for DGF in kidneys with a KDPI score > 30 (p<0.0001), but not in kidneys with a KDPI score < 30. There was no effect of HMP on 1-year or 5-year graft survival.

Conclusion:

In this large, real-world study examining the practice of HMP for deceased-donor kidneys we observed variation in the utilization of HMP, as well as a benefit for HMP in reducing the risk for DGF, particularly in kidneys with high donor risk. Future studies should aim to establish objective clinical markers to guide the use of HMP for deceased donor kidneys.

CITATION INFORMATION: Krishnamoorthy V., Wunsch S., O'Connor K., Souter M. Variation in Hypothermic Machine Perfusion Utilization and Clinical Outcomes for Deceased-Donor Kidneys Am J Transplant. 2017;17 (suppl 3).

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