Hypothermic Machine Perfusion Versus Static Cold Storage in Deceased Donor Kidney Transplantation: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Abstract

Static cold storage (SCS) and hypothermic machine perfusion (HMP) are two primary options for renal allograft preservation. Compared with SCS, HMP decreased the incidence of delayed graft function (DGF) and protected graft function. However, more evidence is still needed to prove the advantages of the HMP. In this study, the outcomes of kidney grafts from the two preservation methods were compared by conducting a systematic review and meta-analysis. Randomized controlled trials (RCTs) comparing the effect of hypothermic machine perfusion and static cold storage in deceased donor kidney transplantation were identified through searches of the MEDLINE, EMBASE, and Cochrane databases between January 1, 1980 and December 30, 2017. The primary endpoints were delayed graft function and graft survival. Secondary endpoints included primary non-function (PNF), graft renal function, duration of DGF, acute rejection, postoperative hospital stay and patient survival. Summary effects were calculated as risk ratio (RR) with 95% confidence interval (CI) or mean difference (MD) with 95% confidence intervals (CI). A total of 13 RCTs were included, including 2048 kidney transplant recipients. The results indicated that compared with SCS, HMP decreased the incidence of DGF (RR 0.78, 95% CI 0.69-0.87, P < 0.0001), and improved the graft survival at 3 years (RR 1.06, 95% CI 1.02-1.11, P = 0.009). There was no significant difference in other endpoints. HMP might be a more desirable method of preservation for kidney grafts. The long-term outcomes of kidney allografts stored by hypothermic machine perfusion still need to be further investigated.

Efficacy of the natural oxygen transporter HEMO 2 life ® in cold preservation in a preclinical porcine model of donation after cardiac death

“…Our results, obtained in a model of severe IRI , suggest that an oxygen carrier such as M101 could be a valuable therapeutic option allowing to improve kidney protection during the hypothermic preservation window. While static CS is not recommended for injured kidneys , the present results support the notion that the use of M101 could improve function recovery, particularly in situations where no other option is available. On the other hand, the MP arm revealed that this technology, currently recommended for high‐risk organs , can be potentiated by M101.…”

Artificial Organs 2019: A year in review

“…Panxin Peng et al of the Peking University China‐Japan Friendship School of Clinical Medicine, Beijing, China investigated as a systemic review and meta‐analysis hypothermic machine perfusion (HMP) versus static cold storage (SCS) in deceased donor kidney transplantation. Randomized controlled trials (RCTs) comparing the effect of hypothermic machine perfusion and static cold storage in deceased donor kidney transplantation were identified through searches of the MEDLINE, EMBASE, and Cochrane databases between January 1, 1980 and December 30, 2017.…”

Effects of Delayed Hypothermic Machine Perfusion on Kidney Grafts with a Preliminary Period of Static Cold Storage and a Total Cold Ischemia Time of Over 24 Hours

“…In deceased-donor kidney transplantation (KT), a prolonged cold ischemia time (CIT) has been identified as an independent risk factor for delayed graft function (DGF), acute rejection (AR), and poor graft survival [1,2]. It has been demonstrated that there is a proportional and independent increase in the risk of graft loss and patient mortality for each additional hour of CIT [2].…”

“…In deceased-donor kidney transplantation (KT), a prolonged cold ischemia time (CIT) has been identified as an independent risk factor for delayed graft function (DGF), acute rejection (AR), and poor graft survival [1,2]. It has been demonstrated that there is a proportional and independent increase in the risk of graft loss and patient mortality for each additional hour of CIT [2]. Furthermore, the extension of donor criteria to meet the transplant demand has led to the inclusion of high-risk categories such as donors after circulatory death (DCD) or donors with advanced age or significant comorbidities, which all show a higher susceptibility to ischemia-reperfusion injury [3].…”