title: The benefits of pulsatile machine perfusion of standard criteria deceased donor kidneys at a geographically remote transplant center.
abstract: Benefits of pulsatile machine perfusion (pumping) of standard criteria donor (SCD) kidneys are unclear. Our center is located 4½ hours from our Organ Procurement Organization. We evaluated outcomes of pumping SCD kidneys under such circumstances by conducting a retrospective examination of all SCD kidneys transplanted between January 2007 and March 2012, comparing kidneys pumped (28 [group 1]) versus standard cold storage (77 [group 2]). Group 1 had fewer delayed graft function (DGF, 3.57% vs. 23.38%, p = 0.02) and slow graft function (SGF, 7.14% vs. 24.68%; p = 0.047) and faster serum creatinine recovery curve (p < 0.001) than group 2. Having a kidney pumped decreases the incidence (odds ratio [OR], 0.059) of DGF, SGF, or primary nonfunction. Group 1 were quicker to reach an estimated glomerular filtration rate (eGFR) >30 ml/min (OR, 4.186; confidence interval [CI], [2.448-7.157]) or an eGFR >60 ml/min (OR, 2.669; CI [1.255-5.679]). Pumping the SCD kidneys in a geographically remote transplant center tended to be better than those preserved in cold storage. However, except recovery curve of serum creatinine during the first postoperative month, other parameters failed to reach statistical significance in the post hoc examination of the contemporary groups. Prospective paired kidney study is required to scrutinize this finding.
authors.affiliation: From the *Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; †Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; and ‡Charleston Area Medical Center, Charleston, West Virginia.
authors.forename: Shih-Chieh Jeff
authors.initials: SC
authors.lastname: Chueh
authors.forename: Bashir R
authors.initials: BR
authors.lastname: Sankari
authors.forename: Lorie
authors.initials: L
authors.lastname: Lipscomb
authors.forename: Asmita
authors.initials: A
authors.lastname: Modak
authors.forename: Michael G
authors.initials: MG
authors.lastname: Castello
authors.forename: Edwin J
authors.initials: EJ
authors.lastname: Avallone
mesh_terms: D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D011673:Pulsatile Flow; D012189:Retrospective Studies; D009927:Tissue and Organ Procurement / Q000379:methods*; D019737:Transplants / Q000502:physiology*