While the causal mechanisms remain elusive, delayed graft function (DGF) has been associated with graft failure in recipients of deceased-donor kidneys. Pulsatile perfusion pump use has been associated with decreased risk of DGF. We hypothesized that pump use might alter the risk of graft failure associated with DGF, but this relationship is poorly understood.

METHODS: Using SRTR, we identified 111,367 first-time, kidney-only, adult recipients who received a deceased-donor kidney between 2000-2015. We modeled survival using Cox proportional hazards models for all-cause graft loss (ACGL) and death-censored graft failure (DCGF), adjusting for donor KDPI, recipient-, and transplant- factors. We used an interaction term to explore the potential effect modification of pump use on DGF.

RESULTS: Among patients receiving a kidney with pump use, DGF was associated with a higher hazard of ACGL (aHR: _1.541.63_1.73) and DCGF (aHR: _1.761.91_2.07). Likewise, among patients receiving a kidney without pump use, DGF was associated with higher hazard of ACGL (aHR: _1.601.66_1.73) and DCGF (aHR: _1.932.04_2.14). Compared to patients who did not receive a kidney with pump use, patients who received a kidney with pump use had a median ACGL survival time of 15.0 yrs (vs. 14.7 yrs) in the absence of DGF and 10.4 yrs (vs. 10.6 yrs) with DGF.

CONCLUSIONS: The effect of DGF on graft failure was modified by pulsatile perfusion pump use. The use of these pumps might reduce the hazard of graft failure for recipients receiving high KDPI kidney transplant.

CITATION INFORMATION: Thomas A, Shaffer A, Massie A, Segev D. Use of Pulsatile Perfusion Modifies the Effect of Delayed Graft Function on Graft Failure. Am J Transplant. 2017;17 (suppl 3).

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