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Outcomes of donation after circulatory death kidneys undergoing hypothermic machine perfusion following static cold storage: A UK population‐based cohort study
Author(s) -
Patel Kamlesh,
Nath Jay,
Hodson James,
Inston Nicholas,
Ready Andrew
Publication year - 2018
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14587
Subject(s) - machine perfusion , medicine , cold storage , confidence interval , creatinine , population , odds ratio , perfusion , renal function , cohort , donation , surgery , urology , transplantation , liver transplantation , environmental health , biology , horticulture , economics , economic growth
Evidence is currently lacking regarding the outcomes of kidneys undergoing hypothermic machine perfusion ( HMP ) in patients in the United Kingdom . Using the National Health Service Blood and Transplant database, the authors compared outcomes for recipients of single‐organ donation after circulatory death ( DCD ) kidneys preserved with HMP with those preserved using only static cold storage ( SCS ). Between 2007 and 2015, HMP was used in 19.1% (864/4,529) of kidneys. Rates of delayed graft function ( DGF ) were significantly lower in organs preserved with HMP than for organs preserved with SCS (34.2% vs 42.0%, P < .001), despite a slightly longer cold ischemic time (median: 14.8 vs 14.1 hours, P < .001). Multivariable analysis found the effect of preservation modality to remain significant, with HMP organs having a significantly lower rate of DGF (odds ratio 0.65, 95% confidence interval 0.53‐0.80, P < .001) and significantly shorter times to DGF resolution (average: 6.1 vs 7.4 days, P = .003) than SCS organs. The patient ( P = .313) and graft ( P = .263) survival rates were similar in the 2 preservation groups. HMP was associated with a marginal functional benefit in 1‐year creatinine values ( P = .044), with adjusted averages of 1.36 mg/ dL ( HMP ) versus 1.40 mg/ dL ( SCS ). This study supports the use of HMP and aids decision‐making over its instigation, which may improve short‐term patient outcomes.