Impact of machine perfusion after long static cold storage on delayed graft function incidence and duration and time to hospital discharge

• Published in: Clinical transplantation Vol. 32; no. 1
• Main Authors: Matos, Ana Cristina C., Requiao Moura, Lúcio Roberto, Borrelli, Milton, Nogueira, Mario, Clarizia, Gabriela, Ongaro, Paula, Durão, Marcelino Souza, Pacheco‐Silva, Alvaro
• Format: Journal Article
• Language: English
• Published: Denmark 01.01.2018
• Subjects: Adult; Cold Ischemia - adverse effects; Cryopreservation; delayed graft function; Delayed Graft Function - epidemiology; Delayed Graft Function - etiology; Delayed Graft Function - pathology; Female; Follow-Up Studies; Glomerular Filtration Rate; Graft Rejection - etiology; Graft Rejection - pathology; Graft Survival; Humans; Incidence; kidney (allograft) function/dysfunction; Kidney Failure, Chronic - surgery; Kidney Function Tests; Kidney Transplantation - adverse effects; Male; Middle Aged; organ perfusion and preservation; Organ Preservation - adverse effects; Patient Discharge; Perfusion; Postoperative Complications; Prognosis; Risk Factors; Tissue and Organ Procurement; kidney (allograft) function/dysfunction; delayed graft function; organ perfusion and preservation
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.13130

Delayed graft function (DGF) is very high in our center (70%‐80%), and we usually receive a kidney for transplant after more than 22 hours of static cold ischemia time (CIT). Also, there is an inadequate care of the donors, contributing to a high rate of DGF. We decided to test whether machine perfusion (MP) after a CIT improved the outcome of our transplant patients. We analyzed the incidence of DGF, its duration, and the length of hospital stay (LOS) in patients who received a kidney preserved with MP after a CIT (hybrid perfusion—HP). We included 54 deceased donors kidneys preserved with HP transplanted from Feb/13 to Jul/14, and compared them to 101 kidney transplants preserved by static cold storage (CS) from Nov/08 to May/12. The median pumping time was 11 hours. DGF incidence was 61.1% vs 79.2% (P = .02), median DGF duration was 5 vs 11 days (P < .001), and median LOS was 13 vs 18 days (P < .011), for the HP compared to CS group. The observed reduction of DGF with machine perfusion did not occur in donors over 50 years old. In the multivariate analysis, risk factors for DGF, adjusted for CIT, were donor age (OR, 1.04; P = .005) and the absence of use of MP (OR, 1.54; P = .051). In conclusion, the use of HP contributed to faster recovery of renal function and to a shorter length of hospital stay.