title: Machine perfusion versus cold storage for the preservation of kidneys from donors ≥ 65 years allocated in the Eurotransplant Senior Programme.
abstract: BACKGROUND
  In the Eurotransplant Senior Programme (ESP), kidneys from donors aged ≥ 65 years are preferentially allocated locally and transplanted into patients aged ≥ 65 years on dialysis. The purpose of this study was to analyse whether the results of transplantation in the ESP can be improved by preservation of organs by hypothermic machine perfusion (MP) compared with simple cold storage (CS).
  
  
  METHODS
  Overall, 85 deceased heart-beating donors ≥ 65 years of age were included in this analysis with follow-up until 1 year post-transplant. For each donor, one kidney was randomly assigned to preservation by CS and the contralateral kidney to MP from organ procurement until transplantation. Delayed graft function (DGF), primary non-function (PNF) and 1-year patient and graft survival rates were evaluated as primary and secondary endpoints.
  
  
  RESULTS
  The median recipient age was 66 years in both groups and the median cold ischaemia time was 11 h for MP and 10.5 h for CS (P = 0.69). The DGF rate was 29.4% for MP and 34.1% for CS (P = 0.58). Only extended duration of cold ischaemia time was an independent risk factor for the development of DGF (odds ratio 1.2, P < 0.0001). PNF was significantly reduced (3.5% MP versus 12.9% CS, P = 0.02). The 1-year patient and graft survival rates were similar for MP and CS (94% versus 95% and 89 versus 81%, P > 0.05). The 1-year graft survival rate was significantly improved after MP in recipients who developed DGF (84% MP versus 48% CS, P = 0.01).
  
  
  CONCLUSIONS
  Continuous pulsatile hypothermic MP for kidneys from donors aged ≥ 65 years can reduce the rate of never-functioning kidneys and improve the 1-year graft survival rate of kidneys with DGF. In this small cohort, the known advantage of MP for the reduction of DGF could not be confirmed, possibly due to relatively short cold ischaemia times.
authors: Clinic for General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany. anja.gallinat@uk-essen.de
authors: Anja
authors: A
authors: Gallinat
authors: Cyril
authors: C
authors: Moers
authors: Jürgen
authors: J
authors: Treckmann
authors: Jacqueline M
authors: JM
authors: Smits
authors: Henry G D
authors: HG
authors: Leuvenink
authors: Rolf
authors: R
authors: Lefering
authors: Ernest
authors: E
authors: van Heurn
authors: Günter R
authors: GR
authors: Kirste
authors: Jean-Paul
authors: JP
authors: Squifflet
authors: Axel
authors: A
authors: Rahmel
authors: Jacques
authors: J
authors: Pirenne
authors: Rutger J
authors: RJ
authors: Ploeg
authors: Andreas
authors: A
authors: Paul
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003080:Cold Temperature; D005060:Europe; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion; D009927:Tissue and Organ Procurement