title: Hypothermic machine perfusion permits extended cold ischemia times with improved early graft function.
abstract: OBJECTIVE
  The logistics of deceased-donor renal transplants are largely affected by cold ischemia time. However, to attain successful outcomes, other issues must be considered. Extending cold ischemia time to accommodate these issues would be valuable. We investigated the role of hypothermic machine perfusion to extend cold ischaemia time.
  
  
  METHODS
  Deceased-donor kidneys were allocated to a storage method, depending on predicted time to operation. Kidneys to be transplanted from 8:00 AM to 8:00 PM in the transplant room remained in static cold storage. If predicted operating time was out of hours, the kidney was transferred to hypothermic machine perfusion and transplanted at the earliest opportunity on the dedicated transplant list.
  
  
  RESULTS
  There were 74 kidneys transplanted from hypothermic machine perfusion and 101 kidneys from static cold storage. Median cold ischemia time was 23.85 hours in the hypothermic machine perfusion group, compared with 13 hours in the static cold storage group (P ≤ .0001). There were 20 kidneys (27%) from hypothermic machine perfusion that had delayed graft function, compared with 47 kidneys (47%) in the static cold storage group (P = .012). There were no other significant differences in graft or postoperative complications.
  
  
  CONCLUSIONS
  This study demonstrated that improved early graft outcomes can be achieved following longer cold ischemia time by using hypothermic machine perfusion rather than static cold storage. This effect is likely multifactorial including the inherent effects of hypothermic machine perfusion, improved recipient preparation, and possibly better perioperative conditions.
authors: From the Department of Renal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
authors: Alison
authors: A
authors: Guy
authors: Damian
authors: D
authors: McGrogan
authors: Nicholas
authors: N
authors: Inston
authors: Andrew
authors: A
authors: Ready
mesh_terms: D000328:Adult; D050377:Cold Ischemia / Q000379:methods*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007668:Kidney / Q000502:physiology*; D016030:Kidney Transplantation / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D013997:Time Factors
chemical_list: D003404:Creatinine