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. 2024 Sep 3:29:e944338.
doi: 10.12659/AOT.944338.

Mechanical Preservation and Delayed Graft Function and Hospital Length of Stay as Deployed in the United States: Analysis of the Last Decade

Douglas S Keith  1 , Elizabeth Lessmann  1
Affiliations

Mechanical Preservation and Delayed Graft Function and Hospital Length of Stay as Deployed in the United States: Analysis of the Last Decade

Douglas S Keith et al. Ann Transplant. .

Abstract

BACKGROUND Mechanical preservation (MP) of deceased donor kidney transplants showed a 30% to 50% reduction in delayed graft function (DGF) as defined by dialysis in the first week, when compared with cold storage. DGF is associated with longer hospital stays and increased costs. In this study, we sought to understand the impact of MP on rates of DGF and length of hospital stays in a contemporary cohort of deceased donor kidney transplants in the United States. MATERIAL AND METHODS All single deceased donor kidney transplants performed between January 1, 2010, and September 2, 2020, were identified in the Scientific Registry of Transplant Recipients database. Donor kidneys were considered pumped if the transplant center received the kidney on the pump. RESULTS Multivariate logistic regression showed that MP had similar odds of reduction of DGF for all subsets of donors. The unadjusted rate of DGF for pumped brain-dead standard criteria donor (BDSCD) recipients was similar to that of donors stored on ice. The rate of DGF for expanded criteria donors (ECD) and donors after cardiac death (DCD) was lower in the recipients who received MP. The similar DGF rates in BDSCD donor recipients were due to longer cold ischemia times in MP kidneys. The lower DGF rates seen in ECD and DCD recipients of pumped kidneys did not translate into a shortened length of hospitalization after transplant. CONCLUSIONS As currently deployed, only DCD and ECD donor recipients of MP kidneys experienced a lower DGF rate. In all subsets of patients, MP did not appreciably shorten the hospital length of stay.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
Delayed graft function (DGF) rate in all deceased donor recipients based on the kidney donor profile index (KDPI) of donor and preservation method. Created with Microsoft Excel, Version 2308 Build 16.0.16731.20542.
Figure 2
Figure 2
Delayed graft function (DGF) rate in donor after cardiac death (DCD) recipients based on the kidney donor profile index (KDPI) of donor and preservation method. Created with Microsoft Excel, Version 2308 Build 16.0.16731.20542.
Figure 3
Figure 3
Distribution of cold ischemia time. (A) Brain-dead standard criteria donor (BDSCD) recipients. (B) Expanded criteria donors (ECD) recipients. (C) Donor after cardiac death (DCD) recipients. Created with Microsoft Excel, Version 2308 Build 16.0.16731.20542.
Figure 4
Figure 4
Delayed graft function (DGF) rate in brain-dead standard criteria donor (BDSCD) recipients based on cold ischemia time and preservation method. Created with Microsoft Excel, Version 2308 Build 16.0.16731.20542.
Figure 5
Figure 5
Distribution of hospital length of stay. (A) Delayed graft function (DGF) or no DGF. (B) Preservation method. Created with Microsoft Excel, Version 2308 Build 16.0.16731.20542.
Figure 6
Figure 6
Distribution of hospital length of stay. (A) Expanded criteria donors (ECD) recipients and preservation method. (B) Donor after cardiac death (DCD) recipients and preservation method. Created with Microsoft Excel, Version 2308 Build 16.0.16731.20542.
See this image and copyright information in PMC

References

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