Comparison of the outcome of kidney transplantation after pulsatile or continuous ex vivo hypothermic machine perfusion of kidneys donated after cardiac death: analysis of kidney pairs
2019
Abstract
Background
Hypothermic machine perfusion is used to improve renal perfusion and reduce the rate of early and late graft dysfunction. It has been used in our unit since 2001. It has two modes of flow: continuous or pulsatile. The aim of this study is to compare the modes of perfusion in terms of perfusion-related parameters, graft survival and estimated glomerular filtration rate.
Methods
All donation after cardiac death kidneys between 2002 and 2014 were reviewed. Sixty-four pairs of kidneys were identified of which one kidney underwent pulsatile and the other continuous perfusion. Machine parameters including resistance and perfusion flow index levels at 0, 1, 2, 3, 4 hours were recorded and glutathione S-transferase measured in perfusate. Delayed graft function frequency, estimated glomerular filtration rate from the 1st week of transplantation until 5th year and graft survival rates were determined.
Results
Machine parameters were similar at all time points. Delayed graft function frequency, estimated glomerular filtration rates and graft survival were equivalent irrespective of perfusion mode.
Conclusion
Pulsatile perfusion may be regarded as more physiological. However, we could not identify differences in short or long term outcomes following transplantation of kidneys from the same donor that had been perfused under pulsatile or continuous conditions.
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