Background Donors from donation after cardiac death(DCD) and expanded criteria donors(ECD) have poorer outcomes compared to standard deceased donors(SCD). It is important to evaluate quality of kidney from DCD/ECD before transplantation. In this study, machine perfusion was used to preserve the DCD/ECD kidneys with the aim to investigating whether the parameters of machine perfusion could predict the quality of kidneys from DCD/ECD donors.

Methods 36 pairs of kidneys from DCD/ECD donors were harvested in our hospital from July 2011 to Aug 2014. All kidneys were preserved with machine perfusion(Life Port), and parameters of machine perfusion were collected. All kidneys were biopsied before transplantation. The kidneys were discarded if histology results showed glomerulosclerosis or interstitial fibrosis were more than 20%. The primary endpoints were delayed graft function(DGF) and graft loss. Postoperative complications and 1-year serum creatinine levels were also recorded.

Results 7 pairs of kidneys(19.4%) were discarded before transplantation. During machine perfusion, 1-hour resistant index(RI) were significantly higher and 1-hour flow rate were significantly lower in discarded kidneys compared to the kidneys that were transplanted(p<0.05). 58 recipients with kidneys transplanted were divided into two groups according to 1-hour RI of machine perfusion. 22 cases in high RI group (RI>0.4) and 36 cases in low RI group( RI ≤0.4). DGF rate were significantly higher in the high RI group(72.7% vs. 27.8%). 1-year serum creatinine levels were also significantly higher in the high RI group(p<0.05). Acute rejection rate and 1-year graft survival were comparable between the two groups.

Conclusion Parameters of machine perfusion are good tools for evaluating quality of kidneys from DCD/ECD donors, and predicting the DGF and 1-year graft function after transplantation.

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