Pulsatile perfusion preservation for expanded-criteria donors kidneys: Impact on delayed graft function rate

Purpose: Expanded criteria donors (ECD) kidneys are a potential solution to organ shortage, but exhibit more delayed graft function (DGF). We conducted a prospective controlled study aiming to evaluate the impact of Pulsatile Perfusion Preservation (PPP) on DGF rate. Methods: Inclusion criteria were: 1) ECD definition (any brain-dead donor aged > 60 years or aged 50-60 years with at least 2 of the following: history of hypertension, terminal serum creatinin level ≥ 1.5 mg/dL, death resulting from a cerebrovascular accident; 2) Donor prolonged circulatory arrest (> 20 mn); 3) previsible cold ischemia time longer than 24 hours. In each pair of kidneys, one organ was preserved with PPP and the other organ was preserved in static cold storage. Results: From February 2007 to September 2009, a total of 22 donors (44 recipients) were included. Recipients were comparable in the two groups with respect to demographic and immunological data. The rate of DGF was significantly lower (9% vs. 31.8%, p=0.021) in the PPP group. At 1, 3, and 12 months, renal function was comparable in the two groups. Conclusions: Pulsatile Perfusion Preservation significantly reduced DGF rate in ECD kidney transplantation.