Maximizing Kidneys for Transplantation Using Machine Perfusion: from the Past to the Future: A Comprehensive Systematic Review and Meta-analysis

Overview

Journal Medicine (Baltimore)

Specialty General Medicine

Date 2016 Oct 18

PMID 27749583

Citations 31

Authors

Ahmer M Hameed

Henry C Pleass

Germaine Wong

Wayne J Hawthorne

Affiliations

Soon will be listed here.

Abstract

Background: The two main options for renal allograft preservation are static cold storage (CS) and machine perfusion (MP). There has been considerably increased interest in MP preservation of kidneys, however conflicting evidence regarding its efficacy and associated costs have impacted its scale of clinical uptake. Additionally, there is no clear consensus regarding oxygenation, and hypo- or normothermia, in conjunction with MP, and its mechanisms of action are also debated. The primary aims of this article were to elucidate the benefits of MP preservation with and without oxygenation, and/or under normothermic conditions, when compared with CS prior to deceased donor kidney transplantation.

Methods: Clinical (observational studies and prospective trials) and animal (experimental) articles exploring the use of renal MP were assessed (EMBASE, Medline, and Cochrane databases). Meta-analyses were conducted for the comparisons between hypothermic MP (hypothermic machine perfusion [HMP]) and CS (human studies) and normothermic MP (warm (normothermic) perfusion [WP]) compared with CS or HMP (animal studies). The primary outcome was allograft function. Secondary outcomes included graft and patient survival, acute rejection and parameters of tubular, glomerular and endothelial function. Subgroup analyses were conducted in expanded criteria (ECD) and donation after circulatory (DCD) death donors.

Results: A total of 101 studies (63 human and 38 animal) were included. There was a lower rate of delayed graft function in recipients with HMP donor grafts compared with CS kidneys (RR 0.77; 95% CI 0.69-0.87). Primary nonfunction (PNF) was reduced in ECD kidneys preserved by HMP (RR 0.28; 95% CI 0.09-0.89). Renal function in animal studies was significantly better in WP kidneys compared with both HMP (standardized mean difference [SMD] of peak creatinine 1.66; 95% CI 3.19 to 0.14) and CS (SMD of peak creatinine 1.72; 95% CI 3.09 to 0.34). MP improves renal preservation through the better maintenance of tubular, glomerular, and endothelial function and integrity.

Conclusions: HMP improves short-term outcomes after renal transplantation, with a less clear effect in the longer-term. There is considerable room for modification of the process to assess whether superior outcomes can be achieved through oxygenation, perfusion fluid manipulation, and alteration of perfusion temperature. In particular, correlative experimental (animal) data provides strong support for more clinical trials investigating normothermic MP.

Citing Articles

Simultaneous Heart and Kidney Transplantation: A Systematic Review and Proportional Meta-Analysis of Its Characteristics and Long-Term Variables.

Sampaio N, Faleiro M, Vieira L, Lech G, Viana S, Tavares C Transpl Int. 2024; 37:12750.

PMID: 38881801 PMC: 11176494. DOI: 10.3389/ti.2024.12750.

A large-scale retrospective study enabled deep-learning based pathological assessment of frozen procurement kidney biopsies to predict graft loss and guide organ utilization.

Yi Z, Xi C, Menon M, Cravedi P, Tedla F, Soto A Kidney Int. 2023; 105(2):281-292.

PMID: 37923131 PMC: 10892475. DOI: 10.1016/j.kint.2023.09.031.

The Impact of Combined Warm and Cold Ischemia Time on Post-transplant Outcomes.

Foley M, Vinson A, Skinner T, Kiberd B, Tennankore K Can J Kidney Health Dis. 2023; 10:20543581231178960.

PMID: 37333478 PMC: 10272701. DOI: 10.1177/20543581231178960.

Hypothermic Perfusion Modifies the Association Between Anti-LG3 Antibodies and Delayed Graft Function in Kidney Recipients.

Mawad H, Pinard L, Medani S, Chagnon M, Boucquemont J, Turgeon J Transpl Int. 2023; 36:10749.

PMID: 36891519 PMC: 9986256. DOI: 10.3389/ti.2023.10749.

Factors Associated With the Use of Hypothermic Machine Perfusion in Kidney Transplant Recipients: A Multicenter Retrospective Cohort Study.

Goulamhoussen N, Slapcoff L, Baran D, Boucher A, Houde I, Masse M Can J Kidney Health Dis. 2022; 9:20543581211048338.

PMID: 36062213 PMC: 9434662. DOI: 10.1177/20543581211048338.

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