O006 A randomised trial of normothermic machine perfusion versus static cold storage in donation after circulatory death renal transplantation

Abstract

Introduction Kidneys from donation after circulatory death (DCD) donors are more susceptible to cold storage (CS) injury and have a high risk of delayed graft function (DGF). This trial is the first to compare normothermic machine perfusion (NMP) to conventional CS in DCD kidney transplantation. Methods In a multicentre randomised control trial, DCD kidneys were randomised to either NMP or CS. NMP kidneys were perfused for 60min with an oxygenated red-cell-based solution (36.0°C) The primary end point was DGF defined as the requirement for dialysis in the first 7days post-transplant. Secondary outcome measures included renal function up to 12 months posttransplant and patient/ graft survival. For all outcome measures a logistic regression model was used adjusted for cold ischaemic time, donor age, left/right kidney and centre. Results February 2016-March 2020, 338 kidneys were randomised into the trial. Twenty-five kidneys did not undergo NMP due to logistical/technical difficulties but were included in an intention-to-treat analysis. Twenty-seven kidneys in the NMP and 21 in the CS group where not transplanted and excluded; 143 NMP and 147 CS kidneys were analysed. There was no significant difference in the rate of DGF (NMP 61% vs CS 58%; P=0.624). Secondary outcome measures demonstrated a significantly higher creatinine reduction ratio day 2(CRR2) (P=0.035) and significantly lower levels of serum creatinine across all timepoints in the NMP group (P=0.024). Conclusion A short end period of NMP did not reduce rates of DGF in DCD kidneys. Secondary outcome measures suggest that NMP may improve renal function. Take-home message This is the first randomised controlled trial of normothermic machine perfusion (NMP) in clinical transplantation. The results suggest that NMP may improve the renal function of DCD kidneys.

Acellular Perfusate is an Adequate Alternative to Packed Red Blood Cells During Normothermic Human Kidney Perfusion

“…10,11 In DCD kidney, transplant of a 1-h period of NMP at the end of SCS did not reduce the rate of DGF compared to SCS alone. 32 The efficacy of NMP for a longer period or continuous (initiated at the donor hospital) NMP needs to be tested for future trials.…”

Organ storage in renal transplantation

“…Hosgood et al also contacted the only randomized control trial investigating the use of NMP. In a multicentered randomized control trial of 338 DCD donor kidney transplants, they found no significant difference in DGF rates (OR 1.13, 95% CI 0.69–1.84, P = 0.62) or secondary outcomes, including PNF, 1-year graft function, graft survival, and acute rejection within 1 year [45 ▪▪ ].…”

Normothermic ex vivo perfusion of deceased donor kidneys and its clinical potential in kidney transplantation outcomes

“…Amongst all three groups, tubular injury was equally low. These studies highlight the potential feasibility of NMP use for a duration longer than 8 h. Recently in the first randomized controlled 2 to compare traditional SCS ( n = 168) with SCS + 1 h NMP ( n = 170) in DCD human kidney transplantations, Hosgood et al 50 demonstrated that 1 h of perfusion does not reduce the occurrence of DGF. Kidney repair and reconditioning…”