Impact of Machine Perfusion on Long-Term Kidney Transplant Outcomes.
1MUHC, Montreal, Canada
2JHU, Baltimore.
Meeting: 2016 American Transplant Congress
Abstract number: 316
Keywords: Graft failure, Kidney transplantation, Preservation
Session Information
Session Name: Concurrent Session: Kidney Transplant Recipient: Long Term Outcomes Session I
Session Type: Concurrent Session
Date: Monday, June 13, 2016
Session Time: 4:30pm-6:00pm
Presentation Time: 5:30pm-5:42pm
Location: Veterans Auditorium
Machine perfusion (MP) has been shown to decrease DGF rates in kidney transplant (KT) recipients when compared with static cold storage (CS). However, there is a paucity of data examining the effect of MP on graft outcomes, particularly those beyond 1 year.
Methods: We conducted a retrospective analysis of 78,207 adult deceased-donor KT recipients using SRTR data from 2006-2013. The cohort was stratified by donor type (SCD-DBD, SCD- DCD, ECD-DBD, ECD-DCD). Outcomes of interest were DGF, all cause graft failure, death-censored graft failure (DCGF) and mortality. We used Cox regression to model the association between MP and graft outcomes, and logistic regression for DGF, adjusting for recipient, donor and transplant characteristics.
Results: When compared with SCD-DBD kidneys (26.7%), more ECD-DCD (87.6%), SCD-DCD (72.4%) and ECD-DBD (53.2%) kidneys underwent MP. MP use was associated with lower risk of DGF in SCD-DBD (OR 0.53, p<0.01), SCD-DCD (OR 0.62 p<0.01) and ECD-DBD (OR 0.53, p<0.01) KTs but not in ECD-DCD KTs (OR 0.77, p=0.3). MP did not affect DCGF, except ECD-DCD KTs where it was associated with 44% lower risk in the 1st year, and ECD-DBD KTs where it was associated with a 15% increased risk after the 1st year
|
Table 1: Hazard ratio for MP use and graft outcomes; significant values in bold |
||||||
|
0-1 year |
95% CI |
p value |
0-5 year |
95% CI |
p value |
|
|
DCGF |
||||||
|
SCD-DBD |
1.03 |
0.93-1.14 |
0.5 |
1.05 |
0.97-1.14 |
0.2 |
|
SCD-DCD |
1.11 |
0.90-1.38 |
0.3 |
1.14 |
0.92-1.42 |
0.2 |
|
ECD-DBD |
1.04 |
0.91-1.19 |
0.5 |
1.15 |
1.01-1.31 |
0.04 |
|
ECD-DCD |
0.56 |
0.32-0.98 |
0.04 |
0.73 |
0.34-1.54 |
0.4 |
|
All cause graft failure |
||||||
|
SCD-DBD |
1.02 |
0.94-1.10 |
0.7 |
1 |
0.94-1.07 |
0.9 |
|
SCD-DCD |
1.11 |
0.94-1.32 |
0.2 |
1.11 |
0.95-1.30 |
0.2 |
|
ECD-DBD |
0.99 |
0.89-1.10 |
0.8 |
1 |
0.91-1.11 |
0.9 |
|
ECD-DCD |
0.59 |
0.38-0.91 |
0.019 |
0.91 |
0.55-1.51 |
0.7 |
|
Mortality |
||||||
|
SCD-DBD |
1.01 |
0.91-1.13 |
0.8 |
0.97 |
0.89-1.05 |
0.2 |
|
SCD-DCD |
1.19 |
0.93-1.51 |
0.2 |
1.15 |
0.95-1.40 |
0.1 |
|
ECD-DBD |
0.96 |
0.83-1.11 |
0.6 |
0.96 |
0.86-1.07 |
0.5 |
|
ECD-DCD |
0.68 |
0.33-1.42 |
0.3 |
0.91 |
0.54-1.54 |
0.7 |
. There was no association between MP use and recipient survival.
Conclusion: Despite lowering DGF rates, MP seems to harm ECD-DBD kidneys; however, in all other categories of donors, there seems to be improvement in either DGF and/or allograft loss.
CITATION INFORMATION: Sandal S, Luo X, Massie A, Cantarovich M, Segev D. Impact of Machine Perfusion on Long-Term Kidney Transplant Outcomes. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Sandal S, Luo X, Massie A, Cantarovich M, Segev D. Impact of Machine Perfusion on Long-Term Kidney Transplant Outcomes. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-of-machine-perfusion-on-long-term-kidney-transplant-outcomes/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress