Hypothermic Machine Perfusion To Optimise the Timing of Renal Transplantation

A. Guy, M. Field, H. Krishnan, N. Inston, A. Ready

Renal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, United Kingdom

Meeting: 2013 American Transplant Congress

Abstract number: D1656

Background

Conflict has always existed between Cold Ischaemic Time (CIT) and safe, timely transplantation. Keeping CIT short may entail operating on complex patients with considerable co-morbidity at times of the day when resources and expertise are limited. UK NCEPOD reports highlight the increased risk of operating at night, particularly for complex patients, whilst changes in medical working patterns have compounded the difficulty of providing appropriate out-of-hours care. This study pilots the use of Hypothermic Machine Perfusion (HMP) to extend CIT, permitting cadaveric renal transplantation to occur at times when resources and expertise are optimal.

Methods

Between December 2011 and October 2012 cadaveric kidneys arriving during normal working hours were transplanted from Static Cold Storage (SCS). Kidneys at risk of being transplanted out-of-hours were placed on HMP and surgery arranged for the following morning on the dedicated transplant list.

Data were gathered prospectively including donor type, method of storage, time of surgery, type of theatre (transplant/emergency) and recipient outcomes (graft function, complications).

Results

Seventy cadaveric renal transplants were performed; 35 kidneys were transplanted from SCS and 35 underwent HMP. Demographics and results are shown below.

Demographics and Results
	SCS (n=35)	HMP (n=35)	P Value
Marginal Kidneys (DCD/ECD)	21	15	0.15*
Mean CIT (hours)	14.97	24.09	<0.0001**
Transplanted Out-Of-Hours	17	5	0.002*
Primary Non-Function (PNF)	2	0	0.15*
Functional DGF (fDGF)***	18	8	0.01*
Delayed Graft Function (DGF)	15	9	0.13*
Cardiorespiratory Complications	7	1	0.02*
Mean Length of Stay (days)	14	11	0.10**
Graft Loss	4	2	0.39*

*Chi squared 2-tailed test **Unpaired 2-tailed t-test ***Defined as the absence of a 10% reduction in creatinine for 3 consecutive days in the first post-op week

Conclusions

HMP extended CIT without increasing fDGF and so allowing more renal transplants to be performed at times when appropriate resources and expertise were available. This may have contributed to fewer cardiovascular complications and shorter hospital stays.

Guy, A.: Grant/Research Support, Organ Recovery Systems. Inston, N.: Grant/Research Support, Organ Recovery Systems. Ready, A.: Grant/Research Support, Organ Recovery Systems.

To cite this abstract in AMA style:

Guy A, Field M, Krishnan H, Inston N, Ready A. Hypothermic Machine Perfusion To Optimise the Timing of Renal Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/hypothermic-machine-perfusion-to-optimise-the-timing-of-renal-transplantation/. Accessed November 23, 2024.

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