Application of machine perfusion preservation as a viability test for marginal kidney graft.
BACKGROUND
This study evaluated the usefulness of machine perfusion preservation parameters as indicators of kidney graft viability.


METHODS
Eighty-eight cadaveric kidneys were analyzed in this study. Of these, 74 kidneys (84.1%) were procured from nonheartbeating donors. The criteria for an acceptable kidney for transplantation were a perfusion flow of more than 0.4 mL/min/g with a concurrent decreasing perfusion pressure. The average perfusion pressure was 30-50 mmHg. We divided the kidneys into three groups: group 1 (n=35), 0.45-0.65 mL/min/g machine perfusion flow (MPF); group 2 (n=30), 0.65-0.90 mL/min/g MPF; and group 3 (n=23), more than 0.9 mL/min/g MPF.


RESULTS
A higher rate of primary nonfunction (PNF; 25.7%) was found in group 1, compared with 6.7% in group 2 and 0% in group 3. A higher rate of 30.4% immediate function was found in group 3, compared with 16.7% in group and 8.6% in group 1. However, a longer period of acute tubular necrosis (ATN; 12.0 days) was found in group 1 compared with 8.6 days in group 2 and 8.7 days in group 3. PNF was detected in 7 (77.8%) cases with more than 16 hr of total ischemic time (TIT) in group 1. In contrast, all of nine cases with more than 16 hr of TIT in group 3 were functional.


CONCLUSIONS
MPF is a reliable indicator of graft viability based on the rate of PNF and immediate renal allograft function, especially in marginal donors.
Matsuno
Naoto
N
The 5th Department of Surgery, Hachioji Medical Center of Tokyo Medical University, Tokyo, Japan. mtn@tokyo-med.ac.jp
Konno
Osamu
O
Mejit
Abudushukur
A
Jyojima
Yoshimaro
Y
Akashi
Isao
I
Nakamura
Yuki
Y
Iwamoto
Hitoshi
H
Hama
Koichiro
K
Iwahori
Toru
T
Ashizawa
Tatsuhito
T
Nagao
Takeshi
T
D000328:Adult; D002102:Cadaver; D015925:Cryopreservation; D005260:Female; D006801:Humans; D007668:Kidney; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000295:instrumentation*; D010477:Perfusion / Q000295:instrumentation*; D013997:Time Factors; D014019:Tissue Donors; D014022:Tissue Survival