title: One-year results of a prospective, randomized trial comparing two machine perfusion devices used for kidney preservation.
abstract: Studies have shown beneficial effects of machine perfusion (MP) on early kidney function and long-term graft survival. The aim of this study was to investigate whether the type of perfusion device could affect outcome of transplantation of deceased donor kidneys. A total of 50 kidneys retrieved from 25 donors were randomized to machine perfusion using a flow-driven (FD) device (RM3; Waters Medical Inc) or a pressure-driven (PD) device (LifePort; Organ Recovery Systems), 24 of these kidneys (n = 12 pairs; 48%) were procured from expanded criteria donors (ECD). The primary endpoints were kidney function after transplantation defined using the incidence of delayed graft function (DGF), the number of hemodialysis sessions required, graft function at 12 months, and analyses of biopsy. DGF was similar in both groups (32%; 8/25). Patients with DGF in the FD group required a mean of 4.66 hemodialysis sessions versus 2.65 in the PD group (P = 0.005). Overall, 1-year graft survival was 80% (20/25) vs. 96% (24/25) in the FD and PD groups. One-year graft survival of ECD kidneys was 66% (8/12) in the FD group versus 92% (11/12) in the PD group. Interstitial fibrosis and tubular atrophy were significantly more common in the FD group - 45% (5/11) vs. 0% (0/9) (P = 0.03) in PD group. There were no differences in creatinine levels between the groups. Machine perfusion using a pressure-driven device generating lower pulse stress is superior to a flow-driven device with higher pulse stress for preserving kidney function.
authors.affiliation: Department of General and Transplantation Surgery, Warsaw Medical University, Warsaw, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Wszola
authors.forename: Artur
authors.initials: A
authors.lastname: Kwiatkowski
authors.forename: Piotr
authors.initials: P
authors.lastname: Diuwe
authors.forename: Piotr
authors.initials: P
authors.lastname: Domagała
authors.forename: Lukasz
authors.initials: L
authors.lastname: Górski
authors.forename: Rafal
authors.initials: R
authors.lastname: Kieszek
authors.forename: Andrzej
authors.initials: A
authors.lastname: Berman
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Perkowska-Ptasińska
authors.forename: Magda
authors.initials: M
authors.lastname: Durlik
authors.forename: Leszek
authors.initials: L
authors.lastname: Pączek
authors.forename: Andrzej
authors.initials: A
authors.lastname: Chmura
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D051799:Delayed Graft Function / Q000503:physiopathology; D005260:Female; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000295:instrumentation* / Q000379:methods; D010477:Perfusion / Q000295:instrumentation* / Q000379:methods; D011446:Prospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement
chemical_list: D015415:Biomarkers
keywords: injury and preservation; injury mechanisms and biomarkers; ischemia/reperfusion injury; machine perfusion; organ preservation; pulsatile preservation