Evaluation of Outcomes in Renal Transplantation Using Machine Perfusion for the Preservation of Kidneys from Expanded Criteria Donor.

E. Savoye, M. Macher, Kidney Working Group, C. Legeai, C. Antoine.

Agence de la Biomedecine, Saint Denis La Plaine, France

Meeting: 2017 American Transplant Congress

Abstract number: C37

Keywords: Donors, Kidney transplantation, marginal, Outcome, Renal ischemia

Session Information

Session Name: Poster Session C: Deceased Donor Issues II: DCD, DGF, AKI, En-Bloc

Session Type: Poster Session

Date: Monday, May 1, 2017

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall D1

Introduction:The shortage of kidney grafts led to retrieve organs from old donors with one or more co-morbidities, considered as “expanded criteria donors” (ECD). In France, since 2012, the Agency of biomedicine (ABM) has recommended the use of machines perfusion (MP) to preserve kidneys from this donor population to improve kidney preservation and the transplantation outcomes, with the creation of a specific lump sum financing the additional costs of this strategy. This study evaluates the impact of MP when MP starts just after kidney procurement at vs cold storage (CS), for the period 2011-2014 with kidneys from ECD.

Methods:From the ABM database (Cristal), the effect of MP on the delayed graft function (DGF) was analyzed using a multivariate logistic model excluding pre-emptive transplants and primary non functions (PNF). In addition, transplants from the same donor, whose one kidney preserved by MP and the other by CS (population of twins), were analyzed using a mixed model.

Results: Co-morbidities of recipients are more frequent and the age of donors and recipients is significantly higher for kidney preserved by MP (n = 801) vs. CS (n = 3515). With 16% of DGF for MP vs. 29% for CS, MP has a protective effect on the DGF (OR adjusted = 0.45, CI [0.36, 0.56]). In the population of the twins (84 pairs, 168 grafts), we observed 7% of DGF for MP vs. 33% for CS and an adjusted OR 0.19 (CI [0.06; 0.58]). The durations of hospitalization and dialysis after transplantation are shorter with fewer sessions of dialysis.

Discussion: Our results confirm the reduction in the incidence of the DGF of ECD kidneys preserved by machines, with 2.2 times less risk despite a population more at risk in this group, and a lower 5.2 times risk in the population of the kidneys "twins". It remains to assess the impact of the DGF in the long term survival and measure the cost effectiveness of this strategy.

CITATION INFORMATION: Savoye E, Macher M, Kidney Working Group, Legeai C, Antoine C. Evaluation of Outcomes in Renal Transplantation Using Machine Perfusion for the Preservation of Kidneys from Expanded Criteria Donor. Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Savoye E, Macher M, Group KidneyWorking, Legeai C, Antoine C. Evaluation of Outcomes in Renal Transplantation Using Machine Perfusion for the Preservation of Kidneys from Expanded Criteria Donor. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/evaluation-of-outcomes-in-renal-transplantation-using-machine-perfusion-for-the-preservation-of-kidneys-from-expanded-criteria-donor/. Accessed November 22, 2024.

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