Date: Tuesday, June 5, 2018
Session Name: Concurrent Session: Kidney: Perioperative Considerations
Session Time: 4:30pm-6:00pm
Presentation Time: 5:18pm-5:30pm
Location: Room 303
Delayed graft function affects around half of all recipients of donation after circulatory death (DCD) kidneys in the UK and has a significant impact on recipient morbidity, hospital stay and costs. The benefits of cold pulsatile machine perfusion for storage and transportation of deceased donor kidneys are disputed. We conducted a randomised trial to compare outcomes of kidneys stored with machine perfusion (MP) versus cold static storage (CS). This is one of the largest randomised trials evaluating the use of machine perfusion in deceased donor kidneys.
This was an open, paired, multi-centre, randomised controlled trial that recruited recipients of DCD kidneys between May 2011 and April 2016. Comparison was made on an 'intention to treat' basis between the two kidneys from each donor and the primary outcome was delayed graft function (DGF).
102 patients were recruited into the study. Median donor age was 60 years (IQR 48-67), recipient age was 57 years (IQR 47-65) and cold ischaemia time was 13.8 hours (IQR 11.2-17.0) and well-matched across the trial groups. DGF was equally common 31/51 (60.8%) in both CS and MP groups. There were no significant differences between CS and MP for 'dialysis-free at 28 days' (CS 45/51(88.2%) vs MP 44/51(86.3%), p= 0.77), primary non-function (CS 1/51(2%) vs MP 0/51(0%), p= 1), slow graft function (41/51(80.3%) vs 39/51(76.5%), p= 0.63), one year death-censored graft survival (CS 94% vs MP 94%, p= 0.95), and one year patient survival (CS 95.9% vs MP 95.3%, p= 0.92). Per protocol analysis did not demonstrate a significant difference between the groups. This study is underpowered and concluded early due to difficulty recruiting patients.
Within the limitations of the study, there is no evidence that machine perfusion improves outcomes for recipients of DCD donor kidneys.
CITATION INFORMATION: Summers D., Randle L., O'Sullivan A-.M., Johnson R., Collett D., Attia M., Ahmad N., Clancy M., Akyol M., Tavakoli A., Jamieson N., Bradley A., Watson C. Cold Pulsatile Machine Perfusion versus Static Cold Storage in Kidneys from Donation after Circulatory Death: A Multi-Centre Randomised Controlled Trial Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Summers D, Randle L, O'Sullivan A-M, Johnson R, Collett D, Attia M, Ahmad N, Clancy M, Akyol M, Tavakoli A, Jamieson N, Bradley A, Watson C. Cold Pulsatile Machine Perfusion versus Static Cold Storage in Kidneys from Donation after Circulatory Death: A Multi-Centre Randomised Controlled Trial [abstract]. https://atcmeetingabstracts.com/abstract/cold-pulsatile-machine-perfusion-versus-static-cold-storage-in-kidneys-from-donation-after-circulatory-death-a-multi-centre-randomised-controlled-trial/. Accessed November 21, 2019.
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