5 years ago

Outcomes of Donation after Circulatory Death kidneys undergoing Hypothermic Machine Perfusion following Static Cold Storage: A UK population-based cohort study

James Hodson, Andrew Ready, Kamlesh Patel, Nick Inston, Jay Nath
Evidence is currently lacking regarding the outcomes of kidneys undergoing Hypothermic Machine Perfusion (HMP) in the UK. Using the National Health Service Blood and Transplant database, the authors compared outcomes for recipients of single organ Donation after Circulatory Death (DCD) kidneys preserved with HMP to those using only static cold storage (SCS). Between 2007 and 2015, HMP was used in 19.1% (864/4,529) of kidneys. Rates of delayed graft function (DGF) were significantly lower in organs preserved with HMP than for SCS (34.2% vs. 42.0%, p<0.001), despite a slightly longer cold ischaemic time (median: 14.8 vs. 14.1hrs, p<0.001). Multivariable analysis found the effect of preservation modality to remain significant, with HMP organs having a significantly lower rate of DGF (Odd ratio 0.65, 95% CI: 0.53–0.80, p<0.001), and significantly shorter times to DGF resolution (average: 6.1 vs. 7.4 days, p=0.003) than SCS organs. Both patient (p=0.313) and graft (p=0.263) survival rates were similar in the two preservation groups. HMP was associated with a marginal functional benefit in 1 year creatinine values (p=0.044), with adjusted averages of 1.36mg/dL (HMP) vs 1.40mg/dL (SCS). This study supports the use of HMP and aids decision making over its instigation, which may improve short-term patient outcomes. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/ajt.14587

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