title: Does the Pulsatile Preservation Machine Have Any Impact in the Discard Rate of Kidneys From Older Donors After Brain Death?
abstract: BACKGROUND
  Donors after brain death (DBD) older than 60 years have become 46.8% of our current activity, with higher risk of renal discard rate (RDR). Assessment of kidney suitability requires complementary strategies: macroscopic evaluation, kidney biopsy score (KBS), and renal hemodynamic evaluation with the Pulsatile Perfusion Machine (PPM).
  
  
  METHODS
  Descriptive, cross-sectional, comparative study of kidneys procured and RDR, comparing 3 time periods: 2000 to June 2004, when only KBS were used; July 2004 to 2008 (introduction of PPM and learning period); and 2009 to 2013 (experienced use of PPM). Transplantation criteria were KBS <3 and PPM renal resistance <0.4 mm Hg/mL/min and arterial renal flow >70 mL/min.
  
  
  RESULTS
  Between 2000 and 2013, a 59.2% reduction in DBD kidneys was observed. However, older kidneys had an increase from 33.5% to 46.8%. The RDR had increased, comparing the first to the third period from 25.4% to 38.3%. However, the RDR was lower when kidneys were evaluated with PPM than those evaluated only with KBS and preserved in cold storage (CS) (21.4% versus 43.7%). There was a significant difference in cold ischemia time, because CS kidney was grafted before PPM. During the third period, more kidneys with KBS ≥4 were assigned to PPM.
  
  
  CONCLUSIONS
  Notwithstanding the decrease in DBD-procured kidneys and the increase in older kidneys during last period, the use of PPM allowed low DR compared with CS. A bias in the results of PPM could be generated when kidneys with higher KBS were excluded from PPM. The use of KBS only to decide acceptance could preclude the use of an additional tool to evaluate suitability.
authors.affiliation: Donation and Transplant Coordination Section, Hospital Clinic, University of Barcelona, Barcelona, Spain. Electronic address: dparedes@clinic.ub.es.
authors.forename: D
authors.initials: D
authors.lastname: Paredes-Zapata
authors.affiliation: Donation and Transplant Coordination Section, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Ruiz-Arranz
authors.affiliation: Donation and Transplant Coordination Section, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Rodriguez-Villar
authors.affiliation: Donation and Transplant Coordination Section, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Roque-Arda
authors.affiliation: Urology Service, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Peri-Cusi
authors.affiliation: Donation and Transplant Coordination Section, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Saavedra-Escobar
authors.affiliation: Donation and Transplant Coordination Section, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Vizcaino-Elias
authors.affiliation: Donation and Transplant Coordination Section, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: X
authors.initials: X
authors.lastname: Garcia-Rodriguez
authors.affiliation: Donation and Transplant Coordination Section, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Bohils-Valle
authors.affiliation: Donation and Transplant Coordination Section, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Rodriguez-Peña
authors.affiliation: Donation and Transplant Coordination Section, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Quijada-Martorell
authors.affiliation: Donation and Transplant Coordination Section, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Gonzalez-Rodriguez
authors.affiliation: Renal Transplant Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Oppenheimer-Salinas
authors.affiliation: Urology Service, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Alcaraz-Asensio
authors.affiliation: Donation and Transplant Coordination Section, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Adalia-Bartolome
mesh_terms: D000367:Age Factors; D000368:Aged; D001926:Brain Death / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D015925:Cryopreservation; D006801:Humans; D016030:Kidney Transplantation; D008875:Middle Aged; D009926:Organ Preservation; D011673:Pulsatile Flow / Q000502:physiology*; D014019:Tissue Donors; D009927:Tissue and Organ Procurement