title: Ex Vivo Perfusion Characteristics of Donation After Cardiac Death Kidneys Predict Long-Term Graft Survival.
abstract: BACKGROUND
  Ex vivo perfusion is used in our unit for kidneys donated after cardiac death (DCD). Perfusion flow index (PFI), resistance, and perfusate glutathione S-transferase (GST) can be measured to assess graft viability. We assessed whether measurements taken during perfusion could predict long-term outcome after transplantation.
  
  
  METHODS
  All DCD kidney transplants performed from 2002 to 2014 were included in this study. The exclusion criteria were: incomplete data, kidneys not machine perfused, kidneys perfused in continuous mode, and dual transplantation. There were 155 kidney transplantations included in the final analysis. Demographic data, ischemia times, donor hypertension, graft function, survival and machine perfusion parameters after 3 hours were analyzed. Each perfusion parameter was divided into 3 groups as high, medium, and low. Estimated glomerular filtration rate was calculated at 12 months and then yearly after transplantation.
  
  
  RESULTS
  There was a significant association between graft survival and PFI and GST (P values, .020 and .022, respectively). PFI was the only independent parameter to predict graft survival.
  
  
  CONCLUSIONS
  A low PFI during ex vivo hypothermic perfusion is associated with inferior graft survival after DCD kidney transplantation. We propose that PFI is a measure of the health of the graft vasculature and that a low PFI indicates vascular disease and therefore predicts a worse long-term outcome.
authors.affiliation: Renal Department, Mus Goverment Hospital, Mus, Turkey. Electronic address: musevinc@hotmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Sevinc
authors.affiliation: Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Stamp
authors.affiliation: Department of Pharmacy Health and Well-Being, University of Sunderland, Sunderland, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Ling
authors.affiliation: Department of Pharmacy Health and Well-Being, University of Sunderland, Sunderland, United Kingdom.
authors.forename: N
authors.initials: N
authors.lastname: Carter
authors.affiliation: Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Talbot
authors.affiliation: Renal Department, Freeman Hospital, Newcastle upon Tyne, United Kingdom; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: N
authors.initials: N
authors.lastname: Sheerin
mesh_terms: D000328:Adult; D003643:Death; D005260:Female; D005982:Glutathione Transferase / Q000032:analysis*; D006085:Graft Survival; D006801:Humans; D006973:Hypertension; D007668:Kidney; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D014019:Tissue Donors
chemical_list: D005982:Glutathione Transferase