Prognostic Utility of Hypothermic Machine Perfusion Correlates with the Kidney Donor Risk Index (KDRI) in Kidney Transplantation, The

S. Patel, O. Pankewycz, B. Mahmood, M. Zachariah, M. Said, L. Feng, A. Desai, J. Brar, M. Laftavi

Transplant Surgery, University at Buffalo, Buffalo, NY
Transplant Nephrology/Medicine, University at Buffalo, Buffalo, NY
UNYTS, Buffalo, NY

Meeting: 2013 American Transplant Congress

Abstract number: D1530

Aim: Hypothermic machine perfusion (MP) improves graft function after kidney transplantation (KT) in both ECD and DCD kidneys. The KDRI incorporates factors that help define both these groups. This study evaluates the correlation between pump perfusion dynamics (PP) and the KDRI as well as it’s predicted outcomes.

Methods: KDRI was calculated on all KTs between 1/2008 and 1/2012 at our institution. All kidneys were pumped on a Lifeport© kidney transporter. Donor variables (Age, BMI, terminal creatinine, comorbidities, DCD status, HCV infection, cause of death) PP (flow (F)ml/min, resistance(R)ml/min/mmHg, pressure(P) mmHg), ischemic (CIT) and pump times, delayed graft function (DGF),S. Cr in mg/dl and eGFR ml/min at 1 year and 1 year death censored graft survival (1 YSR) were studied. KDRI was used to separate the kidneys into 3 groups (≥1.5, 1-1.49 & ≤0.99). The groups were compared using a paired t-test and chi square analysis, and a ‘p’value<0.05 considered significant.

Results: A total of 111 kidneys were divided into the 3 groups. Group 1 was associated with older age (62.8±8 years, p<0.05) and a higher number of ECD kidneys (29/36) p<0.05. BMI was significantly lower in group 3 (25.6 v/s 27.6 and 29.7 p,0.05). Serum creatinine was comparable between the groups. Pump parameters measured at 15 min intervals showed a consistent improvement as KDRIs were lower.

Prognostic markers and graft function after machine perfusion based on KDRI.
	Group 1( KDRI≥1.5	Group 2 (KDRI 1-1.49)	Group 3 (KDRI ≤0.99
n	36	35	40
F average	102±35	120.3±33.8*	130.1±36.2*♣
F terminal	110±35	129.2±31.8*	140.6±36.1*
R average	0.29±0.1	0.23±0.1*	0.21±0.09*
R terminal	0.26±0.01	0.20±0.08*	0.18±0.07*
Pump Time (hours)	10.38±6	9.58±5	10.3±5.3
CIT ( hours)	16.8±4.2	17.25±6	17.9±6
Delayed graft function	7/16 (43.5%)	13/24 (54%)	10/20 (50%)
1 YSR	14/16 (87%)	22/24 (91%)	20/20 (100%)
Projected 1 YSR	<84%	84-89%	89-94%
S. creatinine	1.7±0.3	2.2±1.3	1.23±0.8*♣
e GFR	43.1±11.7	41±12	69±21*♣

* p<0.05 (Group 1v/s2, & Group 1v/s 3). ♣p<0.05 (group 2 v/s 3)

Graft survival was slightly better than predicted by KDRI

Conclusions: Resistance to machine perfusion is higher as the KDRI increases. Amongst all parameters, average flow rates are most likely to reflect this relation. Machine perfusion maintains predicted one year graft survival across increased KDRIs.

To cite this abstract in AMA style:

Patel S, Pankewycz O, Mahmood B, Zachariah M, Said M, Feng L, Desai A, Brar J, Laftavi M. Prognostic Utility of Hypothermic Machine Perfusion Correlates with the Kidney Donor Risk Index (KDRI) in Kidney Transplantation, The [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/prognostic-utility-of-hypothermic-machine-perfusion-correlates-with-the-kidney-donor-risk-index-kdri-in-kidney-transplantation-the/. Accessed November 22, 2024.

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