Cold Pulsatile Perfusion of Deceased Donor Kidneys Substantially Improves Kidney Utilization of Donors After Cardiac Death and Brain Dead Donors with KDPI Greater Than 60%
Kidney Transplant, Ascension Sacred Heart Hospital, Pensacola, FL
Meeting: 2022 American Transplant Congress
Abstract number: 1785
Keywords: Cadaveric organs, Donors, marginal, Kidney, Preservation
Topic: Clinical Science » Organ Inclusive » 68 - Deceased Donor Management and Intervention Research
Session Information
Session Name: Deceased Donor Management and Intervention Research
Session Type: Poster Abstract
Date: Tuesday, June 7, 2022
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: To determine trends in usage of cold pulsatile kidney perfusion and its impact on organ utilization in the United States using the SRTR database.
*Methods: All deceased donors procured with the intention of possible kidney transplant were identified between 1/1/2010 and 9/2/2020. Kidneys procured for research were excluded. The organ disposition was determined from the database. KDPI 2020 was calculated for all the donors. Logistic regression was used to determine the independent impact of pumping on organ utilization. Subset analysis was carried out on ECD and DCD donors.
*Results: 176,594 deceased donor kidneys were identified that were procured for potential kidney transplant. Over the 10 year span, the rate of pumping increased for donors from 31.4% in 2010 to 40.9% in 2019. Among ECD and DCD donors, pumping declined slightly from 38.5% to 36.3%, and from 71.6% to 67.5%, respectively. Figure one shows the relationship between KDPI, preservation type and discard rate.
Discard rates began to diverge at a KDPI of 55-60% with pumped kidneys having a reduced rate of discard. Subset analysis showed DCD kidney discard rates diverging earlier at a KDPI of 20%. Logistic regression of organ discard for all donors with a KDPI of 60% or greater are shown in table one.
Cold pulsatile perfusion of donor kidneys reduced the odds of discard by nearly half (0.505 95% CI 0.482-0.529). A similar impact was seen with all DCD donors (0.479 95% CI 0.447-0.512) Based on deceased donor rates in 2019, if all DCD and brain dead donor kidneys with KDPI of 60% or greater were pumped, around 400 additional kidneys would be utilized a year.
*Conclusions: Cold pulsatile perfusion increased in the last decade but only for brain dead SCD donors. With respect to utilization, pumping is under utilized in the donors most likely to benefit from pumping, ECD and DCD donors. For DCD and brain dead donors with a KDPI of 60% or greater, pulsatile perfusion preservation improved organ utilization and its impact increased with increasing KDPI. Increasing pulsatile cold perfusion rates among these donors could improve donor utilization substantially in the United States.
To cite this abstract in AMA style:
Keith DS, Lessmann E. Cold Pulsatile Perfusion of Deceased Donor Kidneys Substantially Improves Kidney Utilization of Donors After Cardiac Death and Brain Dead Donors with KDPI Greater Than 60% [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/cold-pulsatile-perfusion-of-deceased-donor-kidneys-substantially-improves-kidney-utilization-of-donors-after-cardiac-death-and-brain-dead-donors-with-kdpi-greater-than-60/. Accessed May 18, 2025.« Back to 2022 American Transplant Congress