Hypothermic machine perfusion can safely prolong cold ischemia time in deceased donor kidney transplantation. A retrospective analysis on postoperative morbidity and graft function.
Aged
Allografts
/ blood supply
Cold Ischemia
/ adverse effects
Delayed Graft Function
/ epidemiology
Female
Graft Rejection
/ epidemiology
Graft Survival
Humans
Kidney
/ blood supply
Kidney Transplantation
/ adverse effects
Male
Middle Aged
Organ Preservation
/ instrumentation
Perfusion
/ instrumentation
Postoperative Complications
/ epidemiology
Retrospective Studies
Time Factors
Treatment Outcome
cold ischemia time
delayed graft function
hypothermic machine perfusion
kidney transplant morbidity
kidney transplantation
Journal
Artificial organs
ISSN: 1525-1594
Titre abrégé: Artif Organs
Pays: United States
ID NLM: 7802778
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
revised:
29
09
2020
received:
28
07
2020
accepted:
02
11
2020
pubmed:
20
11
2020
medline:
6
11
2021
entrez:
19
11
2020
Statut:
ppublish
Résumé
In deceased donor kidney transplantation (KT), a prolonged cold ischemia time (CIT) is a negative prognostic factor for KT outcome, and the efficacy of hypothermic machine perfusion (HMP) in prolonging CIT without any additional hazard is highly debated. We conducted a retrospective study on a cohort of 154 single graft deceased donor KTs, in which a delayed HMP, after a preliminary period of static cold storage (SCS), was used to prolong CIT for logistic reasons. Primary outcomes were postoperative complications as well as 1 year graft survival and function. 73 cases (47.4%) were managed with HMP and planned KT, while 81 (52.6%) with SCS and urgent KT. The median CIT in HMP group and SCS group was 29 hour:57 minutes [27-31 hour:45 minutes] and 11 hour:25 minutes [9-14 hour:30 minutes], respectively (P < .001). The period of SCS in the HMP group was significantly shorter than in the SCS group (10 vs. 11 hour:25 minutes, P = .02) as well as the prevalence of expanded criteria donors was significantly higher (43.8% vs. 18.5%, P < .01). After propensity score matching for these two baseline characteristics, the HMP and SCS groups showed comparable outcomes in terms of delayed graft function, vascular, and urologic complications, infections, and episodes of graft rejection. At 1 year follow-up, serum creatinine levels were comparable between the groups. Therefore, the use of HMP to prolong the CIT and convert KT into a planned procedure seemed to have an adequate safety profile, with outcomes comparable to KT managed as an urgent procedure and a CIT nearly three time shorter.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
516-523Informations de copyright
© 2020 International Center for Artificial Organs and Transplantation and Wiley Periodicals LLC.
Références
Moers C, Smits JM, Maathuis MH, Treckmann J, van Gelder F, Napieralski BP, et al. Machine perfusion or cold storage in deceased-donor kidney transplantation. New Engl J Med. 2009;360:7-19.
Peng P, Ding Z, He Y, Zhang J, Wang X, Yang Z. Hypothermic machine perfusion versus static cold storage in deceased donor kidney transplantation: a systematic review and meta-analysis of randomized controlled trials. Artif Organs. 2019;43:478-89.
Tingle SJ, Figueiredo RS, Moir JA, Goodfellow M, Talbot D, Wilson CH. Machine perfusion preservation versus static cold storage for deceased donor kidney transplantation. Cochrane Database Syst Rev. 2019;3:CD011671.
Bellini MI, Nozdrin M, Yiu J, Papalois V. Machine perfusion for abdominal organ preservation: a systematic review of kidney and liver human grafts. J Clin Med. 2019;8:1221.
Gill J, Dong J, Eng M, Landsberg D, Gill JS. Pulsatile perfusion reduces the risk of delayed graft function in deceased donor kidney transplants, irrespective of donor type and cold ischemic time. Transplantation. 2014;97:668-74.
Adani GL, Pravisani R, Crestale S, Baccarani U, Scott CA, D’Alì L, et al. Effects of delayed hypothermic machine perfusion on kidney grafts with a preliminary period of static cold storage and a total cold ischemia time of over 24 hours. Ann Transplant. 2020;25:e918997. https://doi.org/10.12659/AOT.918997
Kox J, Moers C, Monbaliu D, Strelniece A, Treckmann J, Jochmans I, et al. The benefits of hypothermic machine preservation and short cold ischemia times in deceased donor kidneys. Transplantation. 2018;102:1344-50.
Peters-Sengers H, Houtzager JHE, Idu MM, Heemskerk MB, van Heurn EL, van der Heide JJ, et al. Impact of cold ischemia time on outcomes of deceased donor kidney transplantation: an analysis of a national registry. Transplant Direct. 2019;5:e448.
Pravisani R, Isola M, Baccarani U, Crestale S, Tulissi P, Vallone C, et al. Impact of kidney transplant morbidity on elderly recipients' outcomes. Aging Clin Exp Res. 2020 Apr 23. https://doi.org/10.1007/s40520-020-01558-4. [Epub ahead of print]
Bittar J, Arenas P, Chiurchiu C, de la Fuente J, de Arteaga J, Douthat W, et al. Renal transplantation in high cardiovascular risk patients. Transplant Rev (Orlando). 2009;23:224-34.
Kodali L, Turner A. When are you too old to get a kidney transplants? Curr Opin Nephrol Hypertens. 2019;28:593-9.
Pravisani R, Guzzi G, Baccarani U, Avital I, Risaliti A, Livi U, et al. Machine perfusion use for combined staged kidney transplantation after heart re-transplantation: keep calm and stabilize the recipient! Transpl Int. 2020 Jun 1. https://doi.org/10.1111/tri.13660. [Epub ahead of print]
Ekser B, Chen AM, Kubal CA. Delayed kidney transplantation after 83 hours of cold ischemia time in combined liver-kidney transplant. Transplantation. 2019;103:e382-3.
Serrano OK, Vock DM, Chinnakotla S, Dunn TB, Kandaswamy R, Pruett TL, et al. The relationships between cold ischemia time, kidney transplant length of stay, and transplant-related costs. Transplantation. 2019;103:401-11.
Remuzzi G, Cravedi P, Perna A, Dimitrov BD, Turturro M, Locatelli G, et al. Long-term outcome of renal transplantation from older donors. N Engl J Med. 2006;354:343-52.
Adani GL, Pravisani R, Baccarani U, Faion M, Crestale S, Tulissi P, et al. Risk factors for graft loss due to acute vascular complications in adult renal transplantation using grafts without vascular anomalies. Transplant Proc. 2019;51:2939-42.
Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat. 2011;10:150-61.
Nashan B, Abbud-Filho M, Citterio F. Prediction, prevention, and management of delayed graft function: where are we now? Clin Transplant. 2016;30:1198-208.
Mannon RB. Delayed graft function: the AKI of kidney transplantation. Nephron. 2018;140:94-8.
Di Carlo HN, Darras FS. Urologic considerations and complications in kidney transplant recipients. Adv Chronic Kidney Dis. 2015;22:306-11.
Paloyo S, Sageshima J, Gaynor JJ, Chen L, Ciancio G, Burke GW. Negative impact of prolonged cold storage time before machine perfusion preservation in donation after circulatory death kidney transplantation. Transpl Int. 2016;29:1117-25.
Kessler M, Virion JM, Hachicha M, Moulin B, Toupance O, Rebibou JM, et al. Effect of the shipment of cadaveric renal allografts on allograft survival. Nephrol Dial Transplant. 2008;23:1054-60.
Ekser B, Contreras AG, Andraus W, Taner T. Current status of combined liver-kidney transplantation. Int J Surg. 2020;82S:149-54.