Kidneys from donors following cardiac death (DCD) are at risk for inferior outcomes, possibly due to microthrombi and additional warm ischemia. We describe an organ procurement organization (OPO)-wide trial utilizing thrombolytics during machine pulsatile perfusion (MPP).

Methods: Following DCD recovery, a kidney from each pair was prospectively randomized to receive tPA (50 mg Alteplase) or no tPA in the MPP perfusate (850 mL IGL Pulsatile Perfusion Solution). If only one recipient enrolled, that patient received the tPA kidney; if both recipients enrolled in the trial, tPA status was kept blinded.

Results: From 2011 to 2013, 24 kidneys were placed with enrolled recipients from 18 DCD kidney donors. There were no significant differences for absolute values of flow or resistance while undergoing MPP between the groups. Also, discrete flow and resistance targets were reached at similar rates. Recipient demographics and transplant characteristics are shown in the Table. While there was a trend towards lower creatinine (mean±SD), in the tPA group, at 3, 6, and 12 months, these differences were not significant. Delayed graft function (DGF) rates were 41.7% vs 58.4% in the tPA and control group, respectively (p=0.41).

There was one death 70 days post-engraftment in a non-tPA patient, with a second graft failure at 520 days in a non-tPA patient who had chronic poor function and chronic pyelonephritis (Figure).

Conclusion: In this pilot study, encouraging trends are seen in kidney allograft survival and function in DCD kidneys receiving thrombolytic tPA and MPP, compared with standard MPP.

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