Favorable Outcomes With Machine Perfusion and Longer Pump Times in Kidney Transplantation: A Single-Center, Observational Study

Ciancio, Gaetano; Gaynor, Jeffrey J.; Sageshima, Junichiro; Chen, Linda; Roth, David; Kupin, Warren; Guerra, Giselle; Tueros, Lissett; Zarak, Alberto; Hanson, Lois; Ganz, Susan; Ruiz, Phillip; O’Neill, William W.; Livingstone, Alan S.; Burke, George W.

doi:10.1097/tp.0b013e3181f2c962

Cited by 52 publications

(53 citation statements)

References 48 publications

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“…[20][21][22][23][24][25][26][27][28][29] Others studies have suggested that HMP may permit longer CIT without increasing DGF rates. 23,30 The present study supports this concept. Despite the significantly longer CITs in the HMP group, less DGF was experienced than in kidneys stored for shorter periods using SCS.…”

Section: Discussionsupporting

confidence: 80%

Untitled

2015

Exp Clin Transplant

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Objectives: The logistics of deceased-donor renal transplants are largely affected by cold ischemia time. However, to attain successful outcomes, other issues must be considered. Extending cold ischemia time to accommodate these issues would be valuable. We investigated the role of hypothermic machine perfusion to extend cold ischaemia time. Materials and Methods: Deceased-donor kidneys were allocated to a storage method, depending on predicted time to operation. Kidneys to be transplanted from 8:00 AM to 8:00 PM in the transplant room remained in static cold storage. If predicted operating time was out of hours, the kidney was transferred to hypothermic machine perfusion and transplanted at the earliest opportunity on the dedicated transplant list. Results: There were 74 kidneys transplanted from hypothermic machine perfusion and 101 kidneys from static cold storage. Median cold ischemia time was 23.85 hours in the hypothermic machine perfusion group, compared with 13 hours in the static cold storage group (P ≤ .0001). There were 20 kidneys (27%) from hypothermic machine perfusion that had delayed graft function, compared with 47 kidneys (47%) in the static cold storage group (P = .012). There were no other significant differences in graft or postoperative complications. Conclusions:This study demonstrated that improved early graft outcomes can be achieved following longer cold ischemia time by using hypothermic machine perfusion rather than static cold storage. This effect is likely multifactorial including the inherent effects of hypothermic machine perfusion, improved recipient preparation, and possibly better perioperative conditions.

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Section: Discussionsupporting

confidence: 80%

Untitled

2015

Exp Clin Transplant

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“…From the analysis of the differentially expressed genes in this group, most of these genes were downregulated in the noDGF lo group and were found to be involved in intracellular localization and cellular transport. These gene changes may provide a biological explanation to what has been described in the literature as "slow graft function" (26)(27)(28). Finally, few differentially ex- pressed probe sets were identified between the DGF hi and noDGF hi subgroups, indicating that transcriptionally these two groups of patients are very similar.…”

Section: Continuedmentioning

confidence: 78%

Pretransplant Transcriptome Profiles Identify among Kidneys with Delayed Graft Function Those with Poorer Quality and Outcome

Mas

Scian

Archer

et al. 2011

Mol Med

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Robust biomarkers are needed to identify donor kidneys with poor quality associated with inferior early and longer-term outcome. The occurrence of delayed graft function (DGF) is most often used as a clinical outcome marker to capture poor kidney quality. Gene expression profiles of 92 preimplantation biopsies were evaluated in relation to DGF and estimated glomerular filtration rate (eGFR) to identify preoperative gene transcript changes associated with short-term function. Patients were stratified into those who required dialysis during the first week (DGF group) versus those without (noDGF group) and subclassified according to 1-month eGFR of >45 mL/min (eGFR hi ) versus eGFR of ≤45 mL/min (eGFR lo ). The groups and subgroups were compared in relation to clinical donor and recipient variables and transcriptome-associated biological pathways. A validation set was used to confirm target genes. Donor and recipient characteristics were similar between the DGF versus noDGF groups. A total of 206 probe sets were significant between groups (P < 0.01), but the gene functional analyses failed to identify any significantly affected pathways. However, the subclassification of the DGF and noDGF groups identified 283 probe sets to be significant among groups and associated with biological pathways. Kidneys that developed postoperative DGF and sustained an impaired 1-month function (DGF lo group) showed a transcriptome profile of significant immune activation already preimplant. In addition, these kidneys maintained a poorer transplant function throughout the first-year posttransplant. In conclusion, DGF is a poor marker for organ quality and transplant outcome. In contrast, preimplant gene expression profiles identify "poor quality" grafts and may eventually improve organ allocation.

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“…All deceased donor organs were cryopreserved using Water's RM3 Renal Preservation Machine with Belzer-MPS Machine Perfusion Solution (Trans-Med Corp., Elk River, MN) (47).…”

Section: Methodsmentioning

confidence: 99%