Pulsatile machine perfusion vs. cold storage of kidneys for transplantation: a rapid and systematic review

Abstract

Studies of high methodological quality and sufficient size are required to determine whether machine preservation leads to reduce rates of DGF. Predicted impact on graft survival implies that direct evidence would require a large population followed up over a long period of time. Registry database analysis supported by validation of the link between DGF and graft survival may be preferable and more feasible than randomized controlled trials.

Early Allograft Biopsies Performed During Delayed Graft Function May Not Be Necessary Under Thymoglobulin Induction

“…16,25 Despite longer cold ischemia times, recipients of ECD kidneys managed with pulsatile perfusion preservation had similar survival and functional outcomes, but experienced a marked reduction in the rate of DGF. 26 Not all authors agree.…”

“…In the setting of DGF, it has been recommended that biopsies be performed at 1-week intervals, starting 7 days after surgery. 15,16 It is unclear if with immunosuppression based on steroids, tacrolimus, and mycophenolate mofetil, biopsy guidelines should be modified to minimize hospital costs, decrease hospital stay, optimize hospital resources, and limit possible complications. Ideally, the biopsy should not be done when there is little clinical suspicion for and negligible chance of rejection.…”

Expanding Opportunities for Kidney Transplantation

“…Hypothermic machine perfusion (HMP) is an alternative to static cold storage (Figure 3). Several reports have demonstrated improvements in immediate graft function with the use of HMP compared to static cold storage [21][22][23][24]. Additionally, HMP permits longer preservation times without significant consequences to the allograft.…”

Chemical Oxygenation of Pancreatic Tissue Prior to Islet Isolation and Transplantation

“…Several approaches have been performed to improve oxygen supply of retrieved organs during cold storage: (1) Continuous hypothermic machine perfusion (HMP) (Wight et al, 2003, Schold et al, 2005, Treckmann et al, 2011. Modifications of this preservation procedure include the use of continuously oxygenated perfusion media as demonstrated in different animal models (Manekeller et al, 2005, Maathuis et al, 2007, Stegemann et al, 2009.…”