title: Hypothermic machine perfusion reduces delayed graft function and improves one-year graft survival of kidneys from expanded criteria donors: a meta-analysis.
abstract: BACKGROUND
  Expanded criteria donors (ECDs) are currently accepted as potential sources to increase the donor pool and to provide more chances of kidney transplantation for elderly recipients who would not survive long waiting periods. Hypothermic machine perfusion (HMP) is designed to mitigate the deleterious effects of simple cold storage (CS) on the quality of preserved organs, particularly when the donor is in a marginal status.
  
  
  METHODS
  We compared the transplant outcomes in patients receiving ECD kidneys with either HMP or CS graft preservation. Articles from the MEDLINE, EMBASE and Cochrane Library databases were searched and all studies reporting outcomes from HMP versus CS methods of kidney preservation were included in this meta-analysis. The parameters analyzed included the incidence of delayed graft function (DGF), primary non-function (PNF) and one-year graft and patient survival.
  
  
  RESULTS
  A total of seven studies qualified for the review, involving 2374 and 8716 kidney grafts with HMP or CS preservation respectively, all from ECD donors. The incidence of delayed graft function (DGF) was significantly reduced with an odd ratio(OR) of 0.59 (95% CI 0.54-0.66, P<0.001) and one-year graft survival was significantly improved with an OR of 1.12 (95% CI 1.03-1.21, P = 0.005) in HMP preservation compared to CS. However, there was no difference in the incidence of PNF (OR 0.54, 95% CI 0.21-1.40, P = 0.20), and one-year patient survival (OR 0.98, 95% CI 0.94-1.02, P = 0.36) between HMP and CS preservation.
  
  
  CONCLUSIONS
  HMP was associated with a reduced incidence of DGF and an with increased one-year graft survival, but it was not associated with the incidence of PNF and one-year patient survival.
authors: Department of General Surgery, The First Hospital of China Medical University, Shenyang, China.
authors: Baoping
authors: B
authors: Jiao
authors: Shurong
authors: S
authors: Liu
authors: Hao
authors: H
authors: Liu
authors: Donghua
authors: D
authors: Cheng
authors: Ying
authors: Y
authors: Cheng
authors: Yongfeng
authors: Y
authors: Liu
mesh_terms: D018572:Disease-Free Survival; D005260:Female; D006085:Graft Survival; D006801:Humans; D007036:Hypothermia, Induced / Q000295:instrumentation* / Q000379:methods* / Q000401:mortality; D016030:Kidney Transplantation; D016239:MEDLINE; D008297:Male; D010477:Perfusion / Q000295:instrumentation* / Q000379:methods* / Q000401:mortality; D015996:Survival Rate; D014019:Tissue Donors