Machine perfusion preservation versus static cold storage for deceased donor kidney transplantation

Tingle, Samuel J; Figueiredo, Rodrigo; Moir, John; Goodfellow, Michael; Talbot, David; Wilson, Colin

doi:10.1002/14651858.cd011671.pub2

Cited by 150 publications

(230 citation statements)

References 61 publications

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“…Guidance from the Cochrane Handbook for Interventional Systematic Reviews and the PRISMA guidelines (including the PRISMA checklist) were followed for this review . The protocol for the review was published prospectively through Cochrane …”

Section: Methodsmentioning

confidence: 99%

Hypothermic machine perfusion is superior to static cold storage in deceased donor kidney transplantation: A meta‐analysis

Tingle

Figueiredo

Moir

et al. 2020

Clinical Transplantation

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Background There remains a lack of consensus on the optimal storage method for deceased donor kidneys. This meta‐analysis compares storage with hypothermic machine perfusion (HMP) vs traditional static cold storage (SCS). Methods The Cochrane Kidney and Transplant Specialised Register was searched to identify (quasi‐) randomized controlled trials (RCTs) to include in our meta‐analysis. PRISMA guidelines were used to perform and write this review. Results There is high‐certainty evidence that HMP reduces the risk of delayed graft function (DGF) when compared to SCS (2138 participants from 14 studies, RR = 0.77; 0.67‐0.90, P = .0006). This benefit is significant in both donation following circulatory death (DCD; 772 patients from seven studies, RR = 0.75; 0.64‐0.87, P = .0002) and donation following brainstem death (DBD) grafts (971 patients from four studies, RR = 0.78; 0.65‐0.93, P = .006). The number of perfusions required to prevent one episode of DGF was 7.26 and 13.60 in DCD and DBD grafts, respectively. There is strong evidence that HMP also improves graft survival in both DBD and DCD grafts, at both 1 and 3 years. Economic analyses suggest HMP is cost‐saving at 1 year compared with SCS. Conclusion Hypothermic machine perfusion is superior to SCS in deceased donor renal transplantation. Direct comparisons with normothermic machine perfusion in RCTs are essential to identify optimal preservation methods in kidney transplantation.

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Section: Methodsmentioning

confidence: 99%

Hypothermic machine perfusion is superior to static cold storage in deceased donor kidney transplantation: A meta‐analysis

Tingle

Figueiredo

Moir

et al. 2020

Clinical Transplantation

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“…There are several different modalities of ex vivo machine organ perfusion including hypothermic (HMP) and normothermic (EVNP) systems that have both been used in clinical transplantation. A recent Cochrane review found that HMP reduced the risk of DGF compared to static cold storage (RR 0.77, P = 0.0006), with 7.3 and 13.6 kidney perfusions needed to prevent 1 case of DGF in DCD and DBD kidneys, respectively . There were no RCTs comparing HMP and EVNP.…”

Section: Discussionmentioning

confidence: 99%

“…A recent Cochrane review found that HMP reduced the risk of DGF compared to static cold storage (RR 0.77, P = 0.0006), with 7.3 and 13.6 kidney perfusions needed to prevent 1 case of DGF in DCD and DBD kidneys, respectively. 47 There were no RCTs comparing HMP and EVNP. However, HMP has failed to provide accurate methods of assessing organ viability or predicting DGF, 48 suggesting that EVNP may have an added advantage over HMP.…”

Section: E315mentioning

confidence: 99%

Dissemination of a novel organ perfusion technique: ex vivo normothermic perfusion of deceased donor kidneys

et al. 2019

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Ex vivo normothermic perfusion (EVNP) technology is a promising means of organ preservation, assessment, and preconditioning prior to kidney transplantation, which has been pioneered by a single group. We describe the challenges of setting up clinical EVNP programs in 2 new centers, as well as early patient outcomes. Governance, training, and logistical pathways are described. In order to demonstrate safety and proficiency in this new technique, early patient outcomes are also described. Patient outcomes included the incidence of primary nonfunction, delayed graft function, graft and patient survival at 1 year. Contralateral kidneys undergoing static cold storage alone were used as a comparator group. Between March 2016 and July 2017, EVNP was performed on 14 kidneys from 12 donors (11 kidneys in center 1, 3 kidneys in center 2). Of the 14 kidneys that underwent EVNP, 12 organs were implanted into 10 recipients. Two pairs of kidneys were implanted as dual grafts and 1 kidney was implanted simultaneously with a pancreas. The remaining 7 kidneys were transplanted as single allografts. Seven pairs of kidneys were available for paired analysis comparing EVNP versus static cold storage. Graft and patient outcomes were comparable between the 2 preservation techniques. The introduction of a clinical EVNP service requires a careful multimodal approach, drawing on the expertise of specialists in transplantation, hematology, and microbiology. Both new clinical EVNP programs demonstrated proficiency and safety when a structured dissemination process was followed.

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“…The whole spectrum of kidney transplant options is available in Lithuania: preemptive transplantation, living‐related and deceased donor transplantation, paired and ABO incompatible donation, desensitization of highly sensitized recipients, transplantation from a nonheart‐beating donor, and combined kidney transplantation (ie, combined with pancreas, heart or liver). For extended criteria donors, perfusion‐based machine preservation has been used since 2016 . Laparoscopic living donor nephrectomy was introduced in 2017, and the majority of living‐related donors are now managed successfully this way .…”

Section: Modern Kidney Transplantationmentioning

confidence: 99%

“…For extended criteria donors, perfusion-based machine preservation has been used since 2016. 9 Laparoscopic living donor nephrectomy was introduced in 2017, and the majority of living-related donors are now managed successfully this way. 10 Patients from abroad, mostly from the post-Soviet states, come to Lithuania for living-related kidney transplantation.…”

Section: Modern Kidney Transplantationmentioning

confidence: 99%

Lithuania celebrates 50 years of kidney transplantation

2019

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Machine perfusion preservation versus static cold storage for deceased donor kidney transplantation

Abstract: Machine perfusion preservation versus static cold storage for deceased donor kidney transplantation.

Cited by 150 publications

References 61 publications

Hypothermic machine perfusion is superior to static cold storage in deceased donor kidney transplantation: A meta‐analysis

Hypothermic machine perfusion is superior to static cold storage in deceased donor kidney transplantation: A meta‐analysis

Dissemination of a novel organ perfusion technique: ex vivo normothermic perfusion of deceased donor kidneys

Lithuania celebrates 50 years of kidney transplantation

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