Journal-based CME Course: Oxygenated End-Hypothermic Machine Perfusion in Expanded Criteria Donor Kidney Transplant

Activity ID

8240

Expires

June 9, 2024

Format Type

Journal-based

CME Credit

1

Fee

$30

CME Provider: JAMA Surgery

Description of CME Course

Importance  Continuous hypothermic machine perfusion during organ preservation has a beneficial effect on graft function and survival in kidney transplant when compared with static cold storage (SCS).

Objective  To compare the effect of short-term oxygenated hypothermic machine perfusion preservation (end-HMPo₂) after SCS vs SCS alone on 1-year graft survival in expanded criteria donor kidneys from donors who are brain dead.

Design, Setting, and Participants  In a prospective, randomized, multicenter trial, kidneys from expanded criteria donors were randomized to either SCS alone or SCS followed by end-HMPo₂ prior to implantation with a minimum machine perfusion time of 120 minutes. Kidneys were randomized between January 2015 and May 2018, and analysis began May 2019. Analysis was intention to treat.

Interventions  On randomization and before implantation, deceased donor kidneys were either kept on SCS or placed on HMPo₂.

Main Outcome and Measures  Primary end point was 1-year graft survival, with delayed graft function, primary nonfunction, acute rejection, estimated glomerular filtration rate, and patient survival as secondary end points.

Results  Centers in 5 European countries randomized 305 kidneys (median [range] donor age, 64 [50-84] years), of which 262 kidneys (127 [48.5%] in the end-HMPo₂ group vs 135 [51.5%] in the SCS group) were successfully transplanted. Median (range) cold ischemia time was 13.2 (5.1-28.7) hours in the end-HMPo₂ group and 12.9 (4-29.2) hours in the SCS group; median (range) duration in the end-HMPo₂ group was 4.7 (0.8-17.1) hours. One-year graft survival was 92.1% (n = 117) in the end-HMPo₂ group vs 93.3% (n = 126) in the SCS group (95% CI, −7.5 to 5.1; P = .71). The secondary end point analysis showed no significant between-group differences for delayed graft function, primary nonfunction, estimated glomerular filtration rate, and acute rejection.

Conclusions and Relevance  Reconditioning of expanded criteria donor kidneys from donors who are brain dead using end-HMPo₂ after SCS does not improve graft survival or function compared with SCS alone. This study is underpowered owing to the high overall graft survival rate, limiting interpretation.

Trial Registration  isrctn.org Identifier: ISRCTN63852508

Disclaimers

1. This activity is accredited by the American Medical Association.
2. This activity is free to AMA members.

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