BACKGROUND: In the Eurotransplant Senior Programme (ESP), kidneys from donors aged ≥ 65 years are preferentially allocated locally and transplanted into patients aged ≥ 65 years on dialysis. The purpose of this study was to analyse whether the results of transplantation in the ESP can be improved by preservation of organs by hypothermic machine perfusion (MP) compared with simple cold storage (CS). METHODS: Overall, 85 deceased heart-beating donors ≥65 years of age were included in this analysis with follow-up until 1 year post-transplant. For each donor, one kidney was randomly assigned to preservation by CS and the contralateral kidney to MP from organ procurement until transplantation. Delayed graft function (DGF), primary non-function (PNF) and 1-year patient and graft survival rates were evaluated as primary and secondary endpoints. RESULTS: The median recipient age was 66 years in both groups and the median cold ischaemia time was 11 h for MP and 10.5 h for CS (P = 0.69). The DGF rate was 29.4% for MP and 34.1% for CS (P = 0.58). Only extended duration of cold ischaemia time was an independent risk factor for the development of DGF (odds ratio 1.2, P < 0.0001). PNF was significantly reduced (3.5% MP versus 12.9% CS, P = 0.02). The 1-year patient and graft survival rates were similar for MP and CS (94% versus 95% and 89 versus 81%, P > 0.05). The 1-year graft survival rate was significantly improved after MP in recipients who developed DGF (84% MP versus 48% CS, P = 0.01). CONCLUSIONS: Continuous pulsatile hypothermic MP for kidneys from donors aged ≥ 65 years can reduce the rate of never-functioning kidneys and improve the 1-year graft survival rate of kidneys with DGF. In this small cohort, the known advantage of MP for the reduction of DGF could not be confirmed, possibly due to relatively short cold ischaemia times.
RCT Entities:
BACKGROUND: In the Eurotransplant Senior Programme (ESP), kidneys from donors aged ≥ 65 years are preferentially allocated locally and transplanted into patients aged ≥ 65 years on dialysis. The purpose of this study was to analyse whether the results of transplantation in the ESP can be improved by preservation of organs by hypothermic machine perfusion (MP) compared with simple cold storage (CS). METHODS: Overall, 85 deceased heart-beating donors ≥ 65 years of age were included in this analysis with follow-up until 1 year post-transplant. For each donor, one kidney was randomly assigned to preservation by CS and the contralateral kidney to MP from organ procurement until transplantation. Delayed graft function (DGF), primary non-function (PNF) and 1-year patient and graft survival rates were evaluated as primary and secondary endpoints. RESULTS: The median recipient age was 66 years in both groups and the median cold ischaemia time was 11 h for MP and 10.5 h for CS (P = 0.69). The DGF rate was 29.4% for MP and 34.1% for CS (P = 0.58). Only extended duration of cold ischaemia time was an independent risk factor for the development of DGF (odds ratio 1.2, P < 0.0001). PNF was significantly reduced (3.5% MP versus 12.9% CS, P = 0.02). The 1-year patient and graft survival rates were similar for MP and CS (94% versus 95% and 89 versus 81%, P > 0.05). The 1-year graft survival rate was significantly improved after MP in recipients who developed DGF (84% MP versus 48% CS, P = 0.01). CONCLUSIONS:Continuous pulsatile hypothermicMP for kidneys from donors aged ≥ 65 years can reduce the rate of never-functioning kidneys and improve the 1-year graft survival rate of kidneys with DGF. In this small cohort, the known advantage of MP for the reduction of DGF could not be confirmed, possibly due to relatively short cold ischaemia times.
Authors: B Tanriover; S Mohan; D J Cohen; J Radhakrishnan; T L Nickolas; P W Stone; D S Tsapepas; R J Crew; G K Dube; P R Sandoval; B Samstein; E Dogan; R S Gaston; J N Tanriover; L E Ratner; M A Hardy Journal: Am J Transplant Date: 2014-02 Impact factor: 8.086
Authors: Bendix R Slegtenhorst; Frank J M F Dor; Abdala Elkhal; Hector Rodriguez; Xiaoyong Yang; Karoline Edtinger; Markus Quante; Anita S Chong; Stefan G Tullius Journal: Transplantation Date: 2014-06-15 Impact factor: 4.939
Authors: Samuel J Tingle; Rodrigo S Figueiredo; John Ag Moir; Michael Goodfellow; David Talbot; Colin H Wilson Journal: Cochrane Database Syst Rev Date: 2019-03-15
Authors: Marjolein Leemkuil; Grietje Lier; Marten A Engelse; Rutger J Ploeg; Eelco J P de Koning; Nils A 't Hart; Christina Krikke; Henri G D Leuvenink Journal: Transplant Direct Date: 2018-09-07
Authors: Helio Tedesco-Silva; Juliano Chrystian Mello Offerni; Vanessa Ayres Carneiro; Mayara Ivani de Paula; Elias David Neto; Francine Brambate Carvalhinho Lemos; Lúcio Roberto Requião Moura; Alvaro Pacheco E Silva Filho; Mirian de Fátima de Morais Cunha; Erica Francisco da Silva; Luiz Antonio Miorin; Daniela Priscila Demetrio; Paulo Sérgio Luconi; Waldere Tania da Silva Luconi; Savina Adriana Bobbio; Liz Milstein Kuschnaroff; Irene Lourdes Noronha; Sibele Lessa Braga; Renata Cristina Barsante; João Cezar Mendes Moreira; Ida Maria Maximina Fernandes-Charpiot; Mario Abbud-Filho; Luis Gustavo Modelli de Andrade; Paula Dalsoglio Garcia; Luciana Tanajura Santamaria Saber; Alan Fernandes Laurindo; Pedro Renato Chocair; Américo Lourenço Cuvello Neto; Juliana Aparecida Zanocco; Antonio Jose Duboc de Almeida Soares Filho; Wilson Ferreira Aguiar; Jose Medina Pestana Journal: Transplant Direct Date: 2017-04-18