Effect of preservation solutions for static cold storage on kidney transplantation outcomes: A National Registry Study

Abstract

This study aimed to evaluate how 5 preservation solutions for static cold storage affected kidney transplant outcomes. It included all first single kidney transplants during 2010-2014 from donations after brain death in the French national transplant registry, excluding preemptive transplants and transplants of kidneys preserved with a hypothermic perfusion machine. The effects of each preservation solution on delayed graft function (DGF) and 1-year transplant failure were evaluated with hierarchical multivariable logistic regression models. The study finally included 7640 transplanted kidneys: 3473 (45.5%) preserved with Institut Georges Lopez-1 solution (IGL-1), 773 (10.1%) with University of Wisconsin solution, 731 (9.6%) with Solution de Conservation des Organes et Tissus (SCOT, organ and tissue preservation solution), 2215 (29.0%) with Celsior, and 448 (5.9%) with histidine-tryptophan-ketoglutarate. Primary nonfunction rates did not differ by solution. After adjustment for donor, recipient, and transplant characteristics, the DGF risk was significantly lower with IGL-1 than with all other solutions (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.48-0.64). Conversely, SCOT was associated with a DGF risk significantly higher than the other solutions (OR 2.69, 95% CI 2.21-3.27) and triple that of IGL-1 (OR 3.37, 95% CI 2.72-4.16). One year after transplantation, the transplant failure rate did not differ significantly by preservation solution. The difference between the groups for 1-year mean creatinine clearance was not clinically relevant. K E Y W O R D S clinical research/practice, delayed graft function (DGF), health services and outcomes research, kidney failure/injury, kidney transplantation/nephrology, organ perfusion and preservation, organ procurement and allocation 1 | INTRODUC TI ON Given the increased use of grafts from older donors or those with cardiovascular comorbidities and their lower resistance to cold ischemia, the management of organ preservation must be optimized. Different preservation strategies are used in kidney transplantation to minimize injury from cold ischemia and reperfusion. Continuous hypothermic machine perfusion of kidneys from donors after brain death significantly reduces the risk of delayed graft function (DGF) and improves graft survival compared with | 3427 LEGEAI Et AL.

The effect of IGL-1 preservation solution on outcome after kidney transplantation: A retrospective single-center analysis

“…Unweighted incidences of DGF remained below 25% in all groups, with incidences <20% in IGL‐1 and UW. This is considerably lower compared to the DGF rates reported by Legeai et al (23.0% with IGL‐1, 28.9% with UW, and 35.5% with HTK) 21 . Although we do not have a clear explanation for these comparatively low DGF rates, it could be that the relatively low median cold ischemia times in our cohort compared to the cohort reported by Legeai et al contributed.…”

“…It contradicts the main finding of a very recently published French registry study. Legeai et al report that IGL‐1 was associated with the lowest risk of DGF compared to other preservation solutions, with no differences in 1‐year eGFR and 1‐year overall graft survival; functional DGF, acute rejection, and proteinuria were not investigated 21 . As our study included outcomes of 234 IGL‐1 kidneys, it might be that any effect of IGL‐1 remained hidden as DGF rates were relatively low.…”

Lower beta cell yield from donor pancreases after controlled circulatory death prevented by shortening acirculatory warm ischemia time and by using IGL-1 cold preservation solution

“…It has been previously reported that IGL-1 was not inferior to UW when evaluating islet isolation from DBD organs with short CIT [38]. Several studies demonstrated benefits of IGL-1 in preserving abdominal organs including those with long preservation time or ischemic injury [39][40][41]. When compared to UW, the protective effect of IGL-1 has been attributed to its low potassium-sodium ratio and its markedly lower viscosity, due to the use of polyethylene glycol as a colloid instead of hydroxyethyl starch, which is expected to enable higher flow rates and thus a better microcirculation [42].…”

Advances in Kidney Preservation Techniques and Their Application in Clinical Practice

“…Several countries have their own particular preference of solution, for example, IGL-1 is used widely in France but not in other countries. 57 …”

“…Most recently, Legeai et al 57 reviewed the outcome of 5 different SCS solutions used for DBD kidneys in France between 2010 and 2014 (n = 7649). The majority (45.5%) were preserved using IGL-1 solution, 9.6% SCOT solution, 29% Celsior solution, 9.6% UW solution, and 5.9% HTK solution.…”