title: Renal perfusion pump vs cold storage for donation after cardiac death kidneys: a systematic review.
abstract: OBJECTIVE
  Static cold storage is generally used to preserve kidney allografts from deceased donors. Hypothermic machine perfusion may improve the outcome after transplantation but few studies with limited power have addressed this issue. We reviewed evidence of the effectiveness of storing kidneys from deceased donors after cardiac death before transplantation using cold static storage solution or pulsatile hypothermic machine perfusion.
  
  
  METHODS
  We searched electronic databases in September 2011 for systematic reviews and/or meta-analyses, randomized, controlled trials and studies of other designs that compared delayed graft function and graft survival. Sources included The Cochrane Library, PubMed® and EMBASE®. Studies excluded from review included those that did not discriminate between donation after cardiac death and donation from a neurologically deceased donor. Primary outcomes were delayed graft function and 1-year graft survival. Statistical analysis was done using RevMan (http://ims.cochrane.org/revman).
  
  
  RESULTS
  Nine studies qualified for review. Pulsatile perfusion pumped kidneys from donation after cardiac death donors had decreased delayed graft function compared to kidneys placed in cold storage (OR 0.64, 95% CI 0.43-0.95, p = 0.03). There was a trend toward improved 1-year graft survival in the pulsatile perfusion group but statistical significance was not attained (OR 0.74, 95% CI 0.48-1.13, p = 0.17).
  
  
  CONCLUSIONS
  Pulsatile machine perfusion of donation after cardiac death kidneys appears to decrease the delayed graft function rate. We noted no benefit in 1-year graft survival. Due to the great heterogeneity among the trials as well as several confounding factors, the overall impact on allograft function and survival requires more study.
authors.affiliation: Department of Surgery, University of Western Ontario and Multi-Organ Transplant Program, Ontario, Canada.
authors.forename: Varunkumar
authors.initials: V
authors.lastname: Bathini
authors.forename: Thomas
authors.initials: T
authors.lastname: McGregor
authors.forename: Vivian C
authors.initials: VC
authors.lastname: McAlister
authors.forename: Patrick P W
authors.initials: PP
authors.lastname: Luke
authors.forename: Alp
authors.initials: A
authors.lastname: Sener
mesh_terms: D016001:Confidence Intervals; D015925:Cryopreservation / Q000379:methods*; D003643:Death; D051799:Delayed Graft Function / Q000503:physiopathology*; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007260:Infusion Pumps / Q000706:statistics & numerical data*; D007668:Kidney; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods; D008297:Male; D016017:Odds Ratio; D009926:Organ Preservation / Q000379:methods; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D014019:Tissue Donors