Machine perfusion versus cold storage for preservation of kidneys from expanded criteria donors after brain death

Abstract

SummaryThe purpose of this study was to analyze the possible effects of machine perfusion (MP) versus cold storage (CS) on delayed graft function (DGF) and early graft survival in expanded criteria donor kidneys (ECD). As part of the previously reported international randomized controlled trial 91 consecutive heartbeating deceased ECDs -defined according to the United Network of Organ Sharing definition -were included in the study. From each donor one kidney was randomized to MP and the contralateral kidney to CS. All recipients were followed for 1 year. The primary endpoint was DGF. Secondary endpoints included primary nonfunction and graft survival. DGF occurred in 27 patients in the CS group (29.7%) and in 20 patients in the MP group (22%). Using the logistic regression model MP significantly reduced the risk of DGF compared with CS (OR 0.460, P = 0.047). The incidence of nonfunction in the CS group (12%) was four times higher than in the MP group (3%) (P = 0.04). One-year graft survival was significantly higher in machine perfused kidneys compared with cold stored kidneys (92.3% vs. 80.2%, P = 0.02). In the present study, MP preservation clearly reduced the risk of DGF and improved 1-year graft survival and function in ECD kidneys.

Mechanistic Analysis of Nonoxygenated Hypothermic Machine Perfusion’s Protection on Warm Ischemic Kidney Uncovers Greater eNOS Phosphorylation and Vasodilation

“…In expanded criteria donors, MP increases graft survival as well (1)(2)(3)(4). However, the mechanism of this protection remains unclear, which slows down improvements of this technology.…”

“…Abbreviations: Akt, protein kinase B; AMPKa, 5 0 -adenosine monophosphate-activated protein kinase alpha; ANOVA, analysis of variance; CS, cold storage; CTL, control; DCD, donation after circulatory death; eNOS, endothelial nitric oxide synthase; GAPDH, glyceraldehyde-3-phosphate dehydrogenase; iNOS, inducible nitric oxide synthase; KLF2, Kruppel-like factor 2; L19, ribosomal protein L19; L-NAME, NGnitro-L-arginine methyl ester; MP, machine perfusion; MPS, machine perfusion solution; NO, nitric oxide;Introduction Nonoxygenated hypothermic machine perfusion (MP) of kidneys donated after circulatory death (DCD) reduces delayed graft function incidence compared to static cold storage (CS) (1)(2)(3)(4). In expanded criteria donors, MP increases graft survival as well (1)(2)(3)(4).…”

L’ischémie reperfusion

“…D'autres équipes prélèvent rapidement le greffon et le relient à une machine de perfusion pulsatile à 4ºC l'irrigant avec une solution de conservation spécifique [26]. Cette approche a montré des bénéfices en clinique, notamment sur les greffons « à critères élargis » (provenant de donneurs ayant des comorbidités) [27]. Des études expérimentales sont en cours pour évaluer de nouveaux concepts et adopter des conditions plus propices au maintien physiologique des tissus par l'oxygénation du milieu de perfusion [28] ou par l'ajout de transporteurs d'oxygène ou de nutriments [29].…”

Expanded Criteria Donors in Kidney Transplantation: The Role of Older Donors in a Setting of Older Recipients

“…Treckmann et al [77] evaluated the outcome of ECD kidneys comparing the use of machine perfusion and cold storage. When machine perfusion was employed, the risk of DGF decreased significantly (OR 0.460, = 0.047) while the incidence of primary nonfunction in the cold storage group was four times higher than in the machine perfusion group.…”