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. 2022 Sep;46(9):1771-1782.
doi: 10.1111/aor.14308. Epub 2022 May 22.

The role of hypothermic machine perfusion in selecting renal grafts with advanced histological score

Franco Ruberto  1 , Quirino Lai  2 , Mario Piazzolla  1 , Matteo Brisciani  1 , Renzo Pretagostini  2 , Manuela Garofalo  2 , Francesco Giovanardi  2 , Francesco Nudo  2 , Luca Poli  2 , Veronica Zullino  1 , Pietro Santopietro  1 , Massimo Rossi  2 , Pasquale B Berloco  2 , Francesco Pugliese  1
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The role of hypothermic machine perfusion in selecting renal grafts with advanced histological score

Franco Ruberto et al. Artif Organs. 2022 Sep.

Abstract

Background: Few studies explored the role of hypothermic machine perfusion (HMP) in the sub-group of non-standard renal grafts with a biopsy-proven advanced histological impairment. This study aimed to investigate the role of HMP in grafts with a Karpinski Score >3 in terms of the need for dialysis, creatinine reduction ratio at day-7 (CRR7), and 3-year graft survival.

Methods: Twenty-three perfused grafts with Karpinski Score >3 evaluated between November 2017 and December 2018 were retrospectively analyzed and compared with a control group of 32 non-perfused grafts transplanted between January 2014 and October 2017.

Results: After transplantation, perfused grafts had fewer cases requiring dialysis (8.7% vs. 34.4%; p = 0.051), a better reduction in serum creatinine (median at 7 days: 2.2 vs. 4.3 mg/dl; p = 0.045), and shorter length of hospital stay (median 11 vs. 15 days; p = 0.01). Three-year death-censored graft survival was better in the perfused cases (91.3% vs. 77.0%; p = 0.16). In perfused grafts, initial renal resistance (RR) had the best predictive value for renal function recovery after the first week, as defined by CRR7 ≤ 70% (AUC = 0.83; p = 0.02). A cut-off value of 0.5 mm Hg/ml/min showed a sensitivity of 82.4%, a specificity of 83.3%, and diagnostic odds ratio = 23.4. After dividing the entire population into a Low-RR (n = 8) and a High-RR Group (n = 15), more cases with CRR7 ≤ 70% were reported in the latter group (86.7 vs. 13.3%; p = 0.03).

Conclusion: HMP yielded promising results in kidneys with Karpinski Score >3. Initial RR should be of interest in selecting non-standard organs for single kidney transplantation even in impaired histology.

Keywords: Karpinski Score; delayed graft function; dialysis; graft loss; perfusion; serum creatinine.

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Conflict of interest statement

The authors have no conflicts of interest to declare about the present study.

Figures

FIGURE 1
FIGURE 1
Median flow (A) and RR (B) changes during the HMP at different time points in the low‐RR and high‐RR groups. Y‐axis reports the median values of flow expressed in ml/min (A), and the median values of RR expressed in mm Hg/ml/min (B).
FIGURE 2
FIGURE 2
RR changes at different time points observed in the 23 patients transplanted. Y‐axis reports the values of RR expressed in mm Hg/ml/min.
FIGURE 3
FIGURE 3
Three‐year death‐censored graft survival rates observed in the low‐RR perfused, high‐RR perfused, and non‐perfused groups.
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