Machine Perfusion Versus Cold Storage in Transplantation of Kidneys From Older Deceased Donors: Results of a Prospective Randomized Multicenter Trial

Abstract

8 3 MONDAY was similar: 23 6h in CS vs 28 7h in MP (p=NS). in both groups. There were no signifi cant differences between the recipients as to age, gender, duration of ESRD treatment, PRA titres, HLA incompatibility and immunosuppressive treatment. Biopsies were obtained 30 min after reperfusion and snap frozen at 750C. Expression of genes for IL-1b, VEGF, hemoxygenase 1 (HO-1) and hypoxia inducible factor 1 (HIF-1) was analyzed by real-time PCR. Results: Mean Ct for m-RNA expression for HIF-1 in kidney biopsies 30 min after reperfusion were: 0,63 1,54; 1,70 1,08 and 2,11 1,84 for CS, MP and LRD group respectively (p=0.001 for CS vs MP; p=0.001 for CS vs LRD; p=NS for MP vs LRD). Mean m-RNA expression for IL-1b, VEGF and HO-1 did not differ signifi cantly between the groups. Conclusions: Mean m-RNA expression for hypoxia inducible factor 1 is signifi cantly higher in group of kidneys preserved by cold storage in comparison to machine perfusion and living related donors. There is no difference between MP and LRD group regarding expression of HIF-1. Ischemia/reperfusion injury, which can affect early and long-term graft survival is reduced by machine perfusion preservation of cadaveric kidneys. Ischemia/reperfusion injury of kidneys stored by MP is similar to those observed in LRD.

Machine Perfusion for Abdominal Organ Preservation: A Systematic Review of Kidney and Liver Human Grafts

“…Twenty-two studies [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27] identified by the systematic search were included into the analysis (Table 2); fifteen were published papers and seven were abstracts. Ten were RCTs [6,11,12,15,16,18,19,21,24,25], seven studies were retrospective [7,8,9,10,17,22,23], and five were prospective [13,14,20,26,27]. Predominantly, the studies used a LifePort ® kidney transporter for hypothermic machine preservation; there was a large variation in cold storage solution type, with some studies not mentioning the specific cold storage preservation solution, but instead referring to local guidelines.…”

“…Five studies [12,13,15,21,24] which reported PNF (816 patients), demonstrated that HMP significantly decreased primary nonfunction compared to SCS (OR: 0.35 95% CI 1.02 to 2.53, p = 0.003) (Figure 2).…”

“…Twenty-two studies [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27] comparing HMP and SCS described the incidence of DGF (Figure 3), and its duration (Figure 4), with a total of 7963 patients. The overall OR was 0.57 (0.45, 0.72, 95% CI), with p < 0.00001, favouring a statistically significantly lower prevalence of DGF in kidneys preserved by HMP.…”

Systematic review and meta-analysis of hypothermic machine perfusion versus static cold storage of kidney allografts on transplant outcomes

“…A total of 2203 kidneys were included, 1475 of which were from RCTs and were used in the meta‐analysis ( Table ). Recent European studies have been reported in papers with overlapping populations of patients. Results from these studies were requested from the Scientific Steering Committee so that meta‐analysis could be performed without duplicating patients.…”

“…Initial literature searches identified 2619 non‐duplicated references across all databases. Eighteen studies (7 RCTs and 11 non‐RCTs) described in 35 publications met the full inclusion criteria ( Fig . ).…”