Open AccessRenal resistance thresholds during hypothermic machine perfusion and transplantation outcomes – a retrospective cohort study
Author(s) -
Sandal Shaifali,
Paraskevas Steven,
Cantarovich Marcelo,
Baran Dana,
Chaudhury Prosanto,
Tchervenkov Jean I.,
SapirPichhadze Ruth
Publication year - 2018
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13146
Subject(s) - medicine , machine perfusion , hazard ratio , confidence interval , relative risk , retrospective cohort study , proportional hazards model , kidney transplantation , transplantation , cohort , surgery , liver transplantation
Summary Renal resistance ( RR ), of allografts undergoing hypothermic machine perfusion ( HMP ), is considered a measure of organ quality. We conducted a retrospective cohort study of adult deceased donor kidney transplant ( KT ) recipients whose grafts underwent HMP . Our aim was to evaluate whether RR is predictive of death‐censored graft failure ( DCGF ). Of 274 KT eligible for analysis, 59% were from expanded criteria donor. RR was modeled as a categorical variable, using a previously identified terminal threshold of 0.4, and 0.2 mmHg/ ml /min (median in our cohort). Hazard ratios ( HR ) of DCGF were 3.23 [95% confidence interval ( CI ): 1.12–9.34, P = 0.03] and 2.67 [95% CI : 1.14–6.31, P = 0.02] in univariable models, and 2.67 [95% CI : 0.91–7.86, P = 0.07] and 2.42 [95% CI : 1.02–5.72, P = 0.04] in multivariable models, when RR threshold was 0.4 and 0.2, respectively. Increasing risk of DCGF was observed when RR over the course of HMP was modeled using mixed linear regression models: HR of 1.31 [95% CI : 1.07–1.59, P < 0.01] and 1.25 [95% CI : 1.00–1.55, P = 0.05], in univariable and multivariable models, respectively. This suggests that RR during HMP is a predictor of long‐term KT outcomes. Prospective studies are needed to assess the survival benefit of patients receiving KT with higher RR in comparison with staying wait‐listed.