The benefits of hypothermic machine preservation and short cold ischemia times in deceased donor kidneys.
Kox J, Moers C, et al.Transplantation 2018; 102(8): 1344-1350.
Aims
To determine whether kidneys with a short ischemia time (CIT) benefit from hypothermic machine perfusion (HMP), and if HMP can safely extend CIT.
Interventions
This was a post hoc data analysis of the Machine Preservation Trial* data where kidney pairs were randomised and preserved with either HMP or cold storage. A subgroup analysis was performed and the patient cohort was divided into four groups based on the duration of CIT, 0-10 hours, 10-15 hours, 15-20 hours or >20 hours.
Participants
752 kidneys retrieved from 376 DBD or DCD (Maastricht category III) kidney donors aged ≥ 16 years.
Outcomes
The primary outcomes measured was delayed graft function (DGF). Graft survival, the effect of CIT on the risk of DGF, and the effect of perfusion solution were also measured.
Follow-up
1 week and 12 months
CET Conclusions
This paper describes post hoc additional analyses of data from the European machine perfusion trial published in the NEJM nine years ago. This analysis showed that CIT is an independent risk factor for DGF regardless of the preservation method (HMP or static cold storage). Interestingly and surprisingly, the impact of HMP on DGF was largest in the group with the shortest CIT (p=0.002). There was no significant difference in DGF rates between HMP and static cold storage for kidneys stored between 10 and 20 hours! This is probably due to the lack of power when dividing the numbers down so far. Whether the kidneys were on the pump or cold stored, every additional hour of CIT increased the odds for developing DGF by 8%.
Data analysis
Per protocol analysis
Quality notes
Previously assessed as *Moers C, et al. Machine perfusion or cold storage in deceased-donor kidney transplantation. N Engl J Med. 2009; 360(1): 7-19.
Trial registration
ISRCTN - 83876362