Hypothermic machine perfusion as a national standard preservation method for deceased donor kidneys

A. Brat, L.W.E. van Heurn, V.A.L. Huurman, W. de Jongh, H.G.D. Leuvenink, K.M. Ooms - de Vries, A.D. van Zuilen, J. de Jonge, B.J.J.M. Haase - Kromwijk, S.P. Berger, H.S. Hofker

Wednesday 13 march 2019

16:40 - 16:50h at Tropentheater

Categories: Best abstracts, Parallelsessie

Parallel session: Parallelsessie VI – Best abstracts I

Background: Dutch donation and transplantation professionals in collaboration with the Dutch Transplant Foundation have recently completed a two year project to implement non-oxygenated hypothermic machine perfusion (HMP) as standard preservation method for all post mortal donated kidneys. The scope of this study was to assess the effect of the implementation of machine perfusion in daily practice on early outcomes after kidney transplantation.

Methods: Of the kidneys donated and primed for preservation within the Netherlands from January 11^th2016 to December 31^st2017, all kidneys allocated to Dutch recipients were intended to be preserved by HMP. In this analysis also kidneys from DCD donors ≥50 years of age who were randomized in the COPE COMPARE study (oxygenated versus non-oxygenated HMP) were included. A recent historical cohort (2010-2014) with static cold storage (SCS) as standard preservation method was chosen as control group. Follow up data from these transplants were collected via the National Organ Transplant Registry (NOTR). The results of the evaluation included delayed graft function (DGF), graft function defined by eGFR, graft survival one year after transplantation and safety of HMP preservation.

Results: Of all 924 kidneys procured and preserved in the Netherlands during this project, 681 were transplanted in Dutch recipients. Of these kidneys, 82 percent was preserved by HMP. No kidneys were discarded because of the HMP preservation procedure. Within the historical cohort 1812 kidneys from a Dutch donor were transplanted within the Netherlands, all preserved by SCS. DGF occurred in 38 percent of the project cohort versus 46 percent of the historical cohort (p=0,001). A multivariate regression analysis showed an odds ratio of 0,64 for the risk of DGF when using HMP as standard preservation method instead of SCS (p=<0,001). At one year after transplantation the mean eGFR for the project and the historic cohort was 44 (SD 22,3) and 46 (SD 21,4) ml/min/1.73m2 (P=NS), respectively. One year graft survival did not show a significant difference with 94,4 percent in the project cohort, compared to 93 percent in the historical cohort.

Conclusions: The use of hypothermic machine perfusion as standard preservation method for all deceased donor kidneys in the Netherlands was associated with a significant reduction of DGF. To assess long term follow-up results, a longer follow-up period and data is required.