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. 2019 Jan 16:2019:7435248.
doi: 10.1155/2019/7435248. eCollection 2019.

Cold Pulsatile Machine Perfusion versus Static Cold Storage in Kidney Transplantation: A Single Centre Experience

Maria Irene Bellini  1   2 , Sotiris Charalampidis  1 , Paul Elliot Herbert  1   2 , Vasileios Bonatsos  2 , Jeremy Crane  1   2 , Anand Muthusamy  1   2 , Frank J M F Dor  1   2 , Vassilios Papalois  1   2
Affiliations

Cold Pulsatile Machine Perfusion versus Static Cold Storage in Kidney Transplantation: A Single Centre Experience

Maria Irene Bellini et al. Biomed Res Int. .

Abstract

Introduction: We present our experience with hypothermic machine perfusion (HMP) versus cold storage (CS) in relation to kidney transplant outcomes.

Methods: Retrospective analysis of 33 consecutive HMP kidney transplant outcomes matched with those of 33 cold stored: delayed graft function (DGF), length of hospital stay (LOS), estimated glomerular filtration rate (eGFR), and patient and graft survival were compared. Renal Resistive Indexes (RIs) during HMP in relation to DGF were also analysed.

Results: In the HMP group, mean HMP time was 5.7 ± 3.9 hours with a mean cold ischaemic time (CIT) of 15 ± 5.6 versus 15.1 ± 5.3 hours in the CS group. DGF was lower in the HMP group (p=0.041), and donation after Circulatory Death (DCD) was a predictor for DGF (p<0.01). HMP decreased DGF in DCD grafts (p=0.036). Patient and graft survival were similar, but eGFR at 365 days was higher in the HMP cohort (p<0.001). RIs decreased during HMP (p<0.01); 2-hours RI ≥ 0.45 mmHg/mL/min predicted DGF in DCD kidneys (75% sensitivity, 80% specificity; area under the curve 0.78); 2-hours RI ≥ 0.2 mmHg/ml/min predicted DGF in DBD grafts (sensitivity 100%, specificity 91%; area under the curve 0.87).

Conclusion: HMP decreased DGF compared to CS, offering viability assessment pretransplant and improving one-year renal function of the grafts.

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Figures

Figure 1
Figure 1
RI 0: Renal Resistive Index at the beginning of HMP. RI 60: Renal Resistive Index at 60 minutes of HMP. RI 120: Renal Resistive Index at 120 minutes of HMP. RI 180: Renal Resistive Index at 180 minutes of HMP. RIs are measured in mmHg/ml/min. HMP: Hypothermic machine perfusion.
Figure 2
Figure 2
RI 0: Renal Resistive Index at the beginning of HMP. RI 60: Renal Resistive Index at 60 minutes of HMP. RI 120: Renal Resistive Index at 120 minutes of HMP. RI 180: Renal Resistive Index at 180 minutes of HMP. DBD: Donation after Brain Death. DCD: Donation after Circulatory Death. HMP: hypothermic machine perfusion. RIs are measured in mmHg/ml/min.
Figure 3
Figure 3
Receiving Operator Curve (ROC) for Resistive Index at 120 minutes (RI120) ≥ 0.2 mmHg/ml/min in DBD grafts: sensitivity 100%, specificity 91% in DGF prediction. Area under the curve 0.87.
Figure 4
Figure 4
Receiving Operator Curve (ROC) for Resistive Index at 120 minutes (RI120) ≥ 0.45 mmHg/ml/min in DCD grafts: sensitivity 75%, specificity 80% in DGF prediction. Area under the curve 0.78.
Figure 5
Figure 5
Generalised linear model of univariate repeated measures ANOVA. A total of 47 kidney recipients completed 365 days follow up and were analysed (20/33 HMP and 27/33 CS). Mean eGFRs were statistically different during follow up in HMP preserved when compared to CS kidneys (p= 0.039). Post hoc tests using the Bonferroni correction revealed that at day 365 mean eGFRs are higher in the HMP group (p<0.001).
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