title: Influence of pulsatile perfusion preservation on outcomes in kidney transplantation from expanded criteria donors.
abstract: BACKGROUND
  Expanded criteria donors (ECDs) increase the donor organ pool, but the value of transplanting these kidneys has been questioned because of concerns about diminished survival, poorer renal function, and higher rates of delayed graft function.
  
  
  METHODS
  Retrospective analysis of intermediate-term outcomes in ECD kidney transplantations according to method of preservation at a single center using a standardized approach.
  
  
  RESULTS
  Over a 5-year period, we performed 141 donations-after-brain-death ECD kidney transplantations into adult recipients. A total of 114 kidneys (81%) were managed with combined cold-storage and pulsatile perfusion preservation (PPP), and the remaining 27 (19%) were preserved with cold storage (CS). The PPP group had a higher proportion of kidneys preserved for longer than 30 hours (28% versus 0, p < 0.001) and a longer mean cold ischemia time (24.5 hours PPP versus 19 hours CS, p < 0.01). Other donor and recipient characteristics were similar between groups. Incidence of delayed graft function was 11% in PPP-stored kidneys versus 37% in CS kidneys (p = 0.002). With a mean followup of 27 months, patient (91% PPP versus 96% CS) and kidney graft survival (81% PPP versus 81.5% CS) rates were comparable. Mean 12-month serum creatinine (1.9 mg/dL) and calculated Modification of Diet in Renal Disease glomerular filtration rate (41 mL/min) values were similar between groups.
  
  
  CONCLUSIONS
  Despite longer cold ischemia times, recipients of ECD kidneys managed with PPP had similar survival and functional outcomes, but experienced a marked reduction in the rate of delayed graft function.
authors.affiliation: Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157-1095, USA. rstratta@wfubmc.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stratta
authors.forename: Phillip S
authors.initials: PS
authors.lastname: Moore
authors.forename: Alan C
authors.initials: AC
authors.lastname: Farney
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Rogers
authors.forename: Erica L
authors.initials: EL
authors.lastname: Hartmann
authors.forename: Amber
authors.initials: A
authors.lastname: Reeves-Daniel
authors.forename: Michael D
authors.initials: MD
authors.lastname: Gautreaux
authors.forename: Samy S
authors.initials: SS
authors.lastname: Iskandar
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Adams
mesh_terms: D000328:Adult; D002102:Cadaver; D015925:Cryopreservation; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D010477:Perfusion / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement