title: Machine perfusion versus cold storage for preservation of kidneys from expanded criteria donors after brain death.
abstract: The purpose of this study was to analyze the possible effects of machine perfusion (MP) versus cold storage (CS) on delayed graft function (DGF) and early graft survival in expanded criteria donor kidneys (ECD). As part of the previously reported international randomized controlled trial 91 consecutive heart-beating deceased ECDs--defined according to the United Network of Organ Sharing definition--were included in the study. From each donor one kidney was randomized to MP and the contralateral kidney to CS. All recipients were followed for 1 year. The primary endpoint was DGF. Secondary endpoints included primary nonfunction and graft survival. DGF occurred in 27 patients in the CS group (29.7%) and in 20 patients in the MP group (22%). Using the logistic regression model MP significantly reduced the risk of DGF compared with CS (OR 0.460, P=0.047). The incidence of nonfunction in the CS group (12%) was four times higher than in the MP group (3%) (P=0.04). One-year graft survival was significantly higher in machine perfused kidneys compared with cold stored kidneys (92.3% vs. 80.2%, P=0.02). In the present study, MP preservation clearly reduced the risk of DGF and improved 1-year graft survival and function in ECD kidneys. (Current Controlled Trials number: ISRCTN83876362).
authors.affiliation: Clinic for General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstrasse 55, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Treckmann
authors.forename: Cyril
authors.initials: C
authors.lastname: Moers
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Smits
authors.forename: Anja
authors.initials: A
authors.lastname: Gallinat
authors.forename: Mark-Hugo J
authors.initials: MH
authors.lastname: Maathuis
authors.forename: Margitta
authors.initials: M
authors.lastname: van Kasterop-Kutz
authors.forename: Ina
authors.initials: I
authors.lastname: Jochmans
authors.forename: Jaap J
authors.initials: JJ
authors.lastname: Homan van der Heide
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Squifflet
authors.forename: Ernest
authors.initials: E
authors.lastname: van Heurn
authors.forename: Günter R
authors.initials: GR
authors.lastname: Kirste
authors.forename: Axel
authors.initials: A
authors.lastname: Rahmel
authors.forename: Henri G D
authors.initials: HG
authors.lastname: Leuvenink
authors.forename: Jacques
authors.initials: J
authors.lastname: Pirenne
authors.forename: Rutger J
authors.initials: RJ
authors.lastname: Ploeg
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
mesh_terms: D000293:Adolescent; D001926:Brain Death / Q000503:physiopathology; D015925:Cryopreservation / Q000379:methods*; D051799:Delayed Graft Function / Q000503:physiopathology; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000379:methods*; D016016:Proportional Hazards Models; D014019:Tissue Donors / Q000145:classification; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome