Hypothermic Machine Perfusion as a National Standard Preservation Method for Deceased Donor Kidneys

Abstract

Background: Recently, continuous nonoxygenated hypothermic machine perfusion (HMP) has been implemented as standard preservation method for deceased donor kidneys in the Netherlands. This study was designed to assess the effect of the implementation of HMP on early outcomes after transplantation.

Methods: Kidneys donated in the Netherlands in 2016 and 2017 were intended to be preserved by HMP. A historical cohort (2010-2014) preserved by static cold storage was chosen as the control group. Primary outcome was delayed graft function (DGF). Additional analyses were performed on safety, graft function, and survival up until 2 y after transplantation.

Results: Data were collected on 2493 kidneys. Analyses showed significantly more donation after circulatory death, preemptive transplantation, and retransplants in the project cohort. Of the 681 kidneys that were transplanted during the project, 81% were preserved by HMP. No kidneys were discarded due to HMP-related complications. DGF occurred in 38.2% of the project cohort versus 43.7% of the historical cohort (P < 0.001), with a significantly shorter duration within the project cohort (7 versus 9 d, P = 0.003). Multivariate regression analysis showed an odds ratio of 0.69 (95% confidence interval, 0.553-0.855) for the risk of DGF when using HMP compared with cold storage (P = 0.001). There was no significant difference in kidney function, graft survival, and recipient survival up until 2 y posttransplantation.

Conclusions: This study showed that HMP as a standard preservation method for deceased donor kidneys is safe and feasible. HMP was associated with a significant reduction of DGF.

FIGURE 1.

Flowchart of all deceased donor kidneys included in this study. CS, cold storage; HMP, hypothermic machine perfusion.

FIGURE 2.

Forest plot of the effect of the implementation of nonoxygenated HMP on the prevalence on DGF in different donor subgroups. CI, confidence interval; CS, cold storage; DBD, donation after brain death; DCD, donation after circulatory death; DGF, delayed graft function; ECD, expanded criteria donor; HMP, hypothermic machine perfusion; SCD, standard criteria donor.