National Congress of the Spanish Society of Transplantation
Organ retrieval and preservation
Static Cold Storage vs Ex Vivo Machine Perfusion: Results From a Comparative Study on Renal Transplant Outcome in a Controlled Donation After Circulatory Death Program

https://doi.org/10.1016/j.transproceed.2018.12.010Get rights and content

Highlights

  • Ex vivo machine perfusion could attenuate the negative impact of cold ischemia.

  • Outcomes of kidney transplantations were obtained from controlled donations following circulatory death.

Abstract

Introduction

We aimed to evaluate if ex vivo machine perfusion could minimize the negative impact of cold ischemia on those renal grafts obtained from controlled donation after circulatory death (cDCD).

Material and methods

Prospective observational paired study of kidney transplants from cDCD performed in our center. The kidney from each pair preserved on ice was transplanted first within the first few hours following procurement, while the contralateral kidney was machine-perfused with a LifePort device (Organ Recovery Systems, Brussels, Belgium) and transplanted the following day.

Results

A total of 12 cDCDs were included. No differences were observed in delayed graft dysfunction or graft survival between the 2 groups.

Conclusion

The use of ex vivo perfusion devices is simple and they do not require any large infrastructural or high economic investments, considering the fact that it allows a better selection of recipients and viable organs no longer need to be discarded because of prolonged warm ischemia times.

Section snippets

Material and Methods

Prospective observational paired study of kidney transplants from donors after controlled cardiac arrest performed at the Marqués de Valdecilla University Hospital during the period from September 2014 to December 2017.

One kidney from each pair was preserved on ice and transplanted first within the next few hours following procurement (Group A) while the contralateral kidney of the same pair was machine-perfused with a LifePort device (Organ Recovery Systems) and transplanted the day after

Results

During the study period, a total of 12 cDCDs were identified, resulting in 24 renal grafts procured from those donors and transplanted at our center. Cold ischemia time was 6h on average in Group A and 19.9h on average in Group B.

The main characteristics of donors are detailed in Table 1. Twenty-five percent of donors fulfilled the criteria for expanded criteria donors. Both groups were comparable with respect to recipients' characteristics. Cold ischemia time was significantly longer in Group

Discussion

Every year the proportion of cDCDs gains more weight, which contributes to increasing the number of organs eligible for transplantation. Several series have shown that the main disadvantage for using renal grafts from such cDCD donors as compared to DBD donors is the higher rate of delayed graft function, with advanced donor age and prolonged cold ischemia time being identified as extra major risk factors [12].

Ex vivo machine perfusion might offer a solution to this problem, as it might allow

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This work was supported by Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III, Fondo de Desarrollo Regional Europeo (Red de Investigación de Enfermedades Renales “RedInRen” RD16/0009/0027).

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