Hypothermic Machine Perfusion Reduces Delayed Graft Function and Improves One-Year Graft Survival of Kidneys from Expanded Criteria Donors: A Meta-Analysis

Abstract

BackgroundExpanded criteria donors (ECDs) are currently accepted as potential sources to increase the donor pool and to provide more chances of kidney transplantation for elderly recipients who would not survive long waiting periods. Hypothermic machine perfusion (HMP) is designed to mitigate the deleterious effects of simple cold storage (CS) on the quality of preserved organs, particularly when the donor is in a marginal status.MethodsWe compared the transplant outcomes in patients receiving ECD kidneys with either HMP or CS graft preservation. Articles from the MEDLINE, EMBASE and Cochrane Library databases were searched and all studies reporting outcomes from HMP versus CS methods of kidney preservation were included in this meta-analysis. The parameters analyzed included the incidence of delayed graft function (DGF), primary non-function (PNF) and one-year graft and patient survival.ResultsA total of seven studies qualified for the review, involving 2374 and 8716 kidney grafts with HMP or CS preservation respectively, all from ECD donors. The incidence of delayed graft function (DGF) was significantly reduced with an odd ratio(OR) of 0.59 (95% CI 0.54–0.66, P<0.001) and one-year graft survival was significantly improved with an OR of 1.12 (95% CI 1.03–1.21, P = 0.005) in HMP preservation compared to CS. However, there was no difference in the incidence of PNF (OR 0.54, 95% CI 0.21–1.40, P = 0.20), and one-year patient survival (OR 0.98, 95% CI 0.94–1.02, P = 0.36) between HMP and CS preservation.ConclusionsHMP was associated with a reduced incidence of DGF and an with increased one-year graft survival, but it was not associated with the incidence of PNF and one-year patient survival.

Renal Resistance Trend During Hypothermic Machine Perfusion Is More Predictive of Postoperative Outcome Than Biopsy Score: Preliminary Experience in 35 Consecutive Kidney Transplantations

“…Despite the fact that these studies grouped together different categories of donors (standard donors, non‐heart beating donors, expanded criteria donors, etc. ), smaller or retrospective studies, that have specifically examined only one donor type, showed similar results , although no differences in 1‐year graft survival rate were identified. On the basis of these results, several authors asserted that the systematic use of HMP for DCD and ECDs graft reconditioning can be considered cost‐effective in terms of savings for DGF and PNF cases .…”

Advancing Transplantation

“…43 A US registry analysis demonstrated that machine perfusion reduces the risk of DGF and 1-year graft failure by approximately 50% versus cold storage 42 ; however, there was no significant difference in the magnitude of the treatment effect on DGF with SCDs versus ECDs. 42 A meta-analysis demonstrated similar results, 44 whereas in a separate study, graft survival remained significantly higher in the machine perfusion group at year 3. 45 Kwiatkowski et al 46 reported a significant improvement in both graft survival and renal function at 5 years.…”

Organ preservation review

“…When comparing standard static cold storage in kidneys vs. use of HMP for preservation, studies have shown the HMP group kidneys to have a lower incidence of delayed graft function, although there remains controversy regarding long-term graft survival and patient survival rates [39][40][41][42][43][44]. When comparing standard static cold storage in kidneys vs. use of HMP for preservation, studies have shown the HMP group kidneys to have a lower incidence of delayed graft function, although there remains controversy regarding long-term graft survival and patient survival rates [39][40][41][42][43][44].…”