Introduction: Machine perfusion has proven benefits and is common practice among transplant centers. However, the formulas of preservation solutions vary between organ procurement organizations (OPOs). Our aim was to determine if differences in formulas were associated with differences in graft outcomes.

Methods: A telephone survey of all 58 OPOs inquiring about their respective pumping practices was conducted. The formula data were merged to the UNOS transplant recipient data. The final data included transplants of pumped kidneys between 2000 and 2016 (n = 51,372). We performed binomial tests and multivariate logistic regressions to investigate whether the prevalence of delayed graft function (DGF) or primary non-function (PNF) depends on the formula. DGF and PNF were defined as the dialysis requirement during the first week and primary graft failure within 6 months post-transplant respectively.

Results: Thirty-four (58.6%) OPOs use no additives. Seventeen (29.3%) use Mannitol, 9 (15.5%) use Insulin, 6 (10%) use Verapamil, and 6 (10%) use PCN or Ampicillin. PGE, Solumedrol, Arginine & Glutathione, and Sodium Bicarb are each used by 1 (1.7%) OPO. The most common combinations of additives were Mannitol alone (8 OPOs, 13.7%), Mannitol and Verapamil (4 OPOs, 6.9%), and Mannitol, Insulin, Decadron, and PCN/Ampicillin (3 OPOs, 5.1%). The binomial tests indicated that using no additives increases the prevalence of poor outcomes (p=0.011). Among the additive recipients, insulin (p=0.003) and PCN/Ampicillin (p<0.001) reduced the prevalence of poor outcomes. Mannitol and Verapamil additives increased the prevalence of poor EGF (p<0.001 in both cases). The regressions confirmed that insulin and PCN/Ampicillin additives reduce the likelihood of poor outcomes (OR=0.90, p=0.001 and OR=0.91, p=0.011) while Verapamil increased the likelihood (OR=1.10, p=0.009). Mannitol increased the likelihood when it was used in combination with other additives (OR=1.08, p=0.016) while it reduced the likelihood when it was used alone (OR=0.85, p<0.001).

Conclusion: Variations in additive formulas are associated with different effects on early graft outcomes. The standardization of additives across the board through continued outcomes research is needed.

CITATION INFORMATION: Brooks J., Wiederhold P., Jiles K., Chiodo Ortiz A., Dewey M., Bailey M., Koizumi N., Rady E., Ortiz J. Differences in Preservation Solution Formulas and Its Effects on Early Graft Function Am J Transplant. 2017;17 (suppl 3).

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