Background

To overcome organ shortage, utilization of kidneys from DCD donors has increased. Those kidneys have comparable long-term outcomes as DBD kidneys, however they have higher incidence of DGF and worse initial graft function. Published data supports favourable impact of pulsatile Hypothermic Machine Perfusion (HMP) on DCD kidneys.

Aim of this study was to assess the effect of HMP on the early function of controlled DCD kidneys.

Methods

We analysed prospectively collected data of 130 consecutive controlled DCD kidney transplants performed in a single centre between 1 January 2010 and 22 October 2012. Subsequently we compared DCD kidneys preserved on HMP (N=52), using the LifePort© (from Organ Recovery Systems) to DCD kidneys stored in Cold Storage (CS) (N=78). We excluded DCD kidneys transplanted in combination with pancreas and those performed as double transplants.

Results

The mean donor age in HMP group was 59.09±1.83 years (mean±SD) and 56.26±11.14 years in CS group (p=0.28). There was no significant difference in recipient age 59.65±19.84 years in HMP group vs. 57.85±12.13 years in CS (p= 0.40); however Cold Ischaemia Time (CIT) was significantly longer in HMP group (14.73±4.3 hours) compared to CS group (11.32±4.5 hours), p<0.001. We found no difference in the incidence of functional DGF, 65.4% and 74.4% in HMP and CS groups repectively (p=0.27). Also, the eGFRs were similar at any time point.

In a logistic regression analysis, we found that higher donor age (Exp(B)=1.029, p=0.038), longer CIT (Exp(B)=1.114, p=0.031) and CS as the type of storage (Exp(B)=2.5, p=0.043), were significantly increasing the risk of DGF.

In linear regression analysis the donor age, CIT, and type of storage showed significant correlation with the eGFR at 1, 3 and 6 months. At 1 and 2 years only the donor age correlated significantly with the eGFR.

Summary

HMP, in DCD kidneys with long CIT, can neutralise the adverse effect of cold preservation, leading to at least equivalent early graft function and similar incidence of DGF compared to kidneys preserved by static CS for significantly shorter preservation time.

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