Hypothermic Machine Perfusion as a National Standard Preservation Method for Deceased Donor Kidneys

Aukje Brat; Kirsten M. De Vries; Ernst W.E. Van Heurn; Volkert A.L. Huurman; Wim De Jongh; Henri G.D. Leuvenink; Arjan D. Van Zuilen; Bernadette J.J.M. Haase-Kromwijk; Jeroen De Jonge; Stefan P. Berger; Sijbrand H. Hofker

doi:10.1097/TP.0000000000003845

Hypothermic Machine Perfusion as a National Standard Preservation Method for Deceased Donor Kidneys

Aukje Brat^*, Kirsten M. De Vries, Ernst W.E. Van Heurn, Volkert A.L. Huurman, Wim De Jongh, Henri G.D. Leuvenink, Arjan D. Van Zuilen, Bernadette J.J.M. Haase-Kromwijk, Jeroen De Jonge, Stefan P. Berger, Sijbrand H. Hofker

^*Corresponding author for this work

Surgery

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Abstract

Background. Recently, continuous nonoxygenated hypothermic machine perfusion (HMP) has been implemented as standard preservation method for deceased donor kidneys in the Netherlands. This study was designed to assess the effect of the implementation of HMP on early outcomes after transplantation.

Methods. Kidneys donated in the Netherlands in 2016 and 2017 were intended to be preserved by HMP. A historical cohort (2010-2014) preserved by static cold storage was chosen as the control group. Primary outcome was delayed graft function (DGF). Additional analyses were performed on safety, graft function, and survival up until 2 y after transplantation.

Results. Data were collected on 2493 kidneys. Analyses showed significantly more donation after circulatory death, preemptive transplantation, and retransplants in the project cohort. Of the 681 kidneys that were transplanted during the project, 81% were preserved by HMP. No kidneys were discarded due to HMP-related complications. DGF occurred in 38.2% of the project cohort versus 43.7% of the historical cohort (P < 0.001), with a significantly shorter duration within the project cohort (7 versus 9 d, P = 0.003). Multivariate regression analysis showed an odds ratio of 0.69 (95% confidence interval, 0.553-0.855) for the risk of DGF when using HMP compared with cold storage (P = 0.001). There was no significant difference in kidney function, graft survival, and recipient survival up until 2 y posttransplantation.

Conclusions. This study showed that HMP as a standard preservation method for deceased donor kidneys is safe and feasible. HMP was associated with a significant reduction of DGF.

Original language	English
Pages (from-to)	1043-1050
Number of pages	8
Journal	Transplantation
Volume	106
Issue number	5
DOIs	https://doi.org/10.1097/TP.0000000000003845
Publication status	Published - May 2022

Bibliographical note

Funding Information:
The logistical service was adapted from the randomized controlled trial COPE COMPARE. In this RCT, only 2 perfusion hubs were operational to offer support at the donation and transplant sites. In March of 2017, the number of perfusion hubs was increased to 3, allowing a more efficient coverage of the country. Initially, both procuring and transplant teams were supported on-site by the TTs from the perfusion hubs. To reduce costs, local TTs were introduced, being responsible for assisting the transplant team and returning the machines to the perfusion hub by regular courier service.

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.

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Brat, A., De Vries, K. M., Van Heurn, E. W. E., Huurman, V. A. L., De Jongh, W., Leuvenink, H. G. D., Van Zuilen, A. D., Haase-Kromwijk, B. J. J. M., De Jonge, J., Berger, S. P., & Hofker, S. H. (2022). Hypothermic Machine Perfusion as a National Standard Preservation Method for Deceased Donor Kidneys. Transplantation, 106(5), 1043-1050. https://doi.org/10.1097/TP.0000000000003845

@article{7ce9071f559649b3902eb85f96e8f47c,

title = "Hypothermic Machine Perfusion as a National Standard Preservation Method for Deceased Donor Kidneys",

abstract = "Background. Recently, continuous nonoxygenated hypothermic machine perfusion (HMP) has been implemented as standard preservation method for deceased donor kidneys in the Netherlands. This study was designed to assess the effect of the implementation of HMP on early outcomes after transplantation. Methods. Kidneys donated in the Netherlands in 2016 and 2017 were intended to be preserved by HMP. A historical cohort (2010-2014) preserved by static cold storage was chosen as the control group. Primary outcome was delayed graft function (DGF). Additional analyses were performed on safety, graft function, and survival up until 2 y after transplantation. Results. Data were collected on 2493 kidneys. Analyses showed significantly more donation after circulatory death, preemptive transplantation, and retransplants in the project cohort. Of the 681 kidneys that were transplanted during the project, 81% were preserved by HMP. No kidneys were discarded due to HMP-related complications. DGF occurred in 38.2% of the project cohort versus 43.7% of the historical cohort (P < 0.001), with a significantly shorter duration within the project cohort (7 versus 9 d, P = 0.003). Multivariate regression analysis showed an odds ratio of 0.69 (95% confidence interval, 0.553-0.855) for the risk of DGF when using HMP compared with cold storage (P = 0.001). There was no significant difference in kidney function, graft survival, and recipient survival up until 2 y posttransplantation. Conclusions. This study showed that HMP as a standard preservation method for deceased donor kidneys is safe and feasible. HMP was associated with a significant reduction of DGF.",

author = "Aukje Brat and {De Vries}, {Kirsten M.} and {Van Heurn}, {Ernst W.E.} and Huurman, {Volkert A.L.} and {De Jongh}, Wim and Leuvenink, {Henri G.D.} and {Van Zuilen}, {Arjan D.} and Haase-Kromwijk, {Bernadette J.J.M.} and {De Jonge}, Jeroen and Berger, {Stefan P.} and Hofker, {Sijbrand H.}",

note = "Funding Information: The logistical service was adapted from the randomized controlled trial COPE COMPARE. In this RCT, only 2 perfusion hubs were operational to offer support at the donation and transplant sites. In March of 2017, the number of perfusion hubs was increased to 3, allowing a more efficient coverage of the country. Initially, both procuring and transplant teams were supported on-site by the TTs from the perfusion hubs. To reduce costs, local TTs were introduced, being responsible for assisting the transplant team and returning the machines to the perfusion hub by regular courier service. Publisher Copyright: {\textcopyright} 2022 Lippincott Williams and Wilkins. All rights reserved.",

year = "2022",

month = may,

doi = "10.1097/TP.0000000000003845",

language = "English",

volume = "106",

pages = "1043--1050",

journal = "Transplantation",

issn = "0041-1337",

publisher = "Lippincott Williams & Wilkins",

number = "5",

}

TY - JOUR

T1 - Hypothermic Machine Perfusion as a National Standard Preservation Method for Deceased Donor Kidneys

AU - Brat, Aukje

AU - De Vries, Kirsten M.

AU - Van Heurn, Ernst W.E.

AU - Huurman, Volkert A.L.

AU - De Jongh, Wim

AU - Leuvenink, Henri G.D.

AU - Van Zuilen, Arjan D.

AU - Haase-Kromwijk, Bernadette J.J.M.

AU - De Jonge, Jeroen

AU - Berger, Stefan P.

AU - Hofker, Sijbrand H.

N1 - Funding Information: The logistical service was adapted from the randomized controlled trial COPE COMPARE. In this RCT, only 2 perfusion hubs were operational to offer support at the donation and transplant sites. In March of 2017, the number of perfusion hubs was increased to 3, allowing a more efficient coverage of the country. Initially, both procuring and transplant teams were supported on-site by the TTs from the perfusion hubs. To reduce costs, local TTs were introduced, being responsible for assisting the transplant team and returning the machines to the perfusion hub by regular courier service. Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.

PY - 2022/5

Y1 - 2022/5

N2 - Background. Recently, continuous nonoxygenated hypothermic machine perfusion (HMP) has been implemented as standard preservation method for deceased donor kidneys in the Netherlands. This study was designed to assess the effect of the implementation of HMP on early outcomes after transplantation. Methods. Kidneys donated in the Netherlands in 2016 and 2017 were intended to be preserved by HMP. A historical cohort (2010-2014) preserved by static cold storage was chosen as the control group. Primary outcome was delayed graft function (DGF). Additional analyses were performed on safety, graft function, and survival up until 2 y after transplantation. Results. Data were collected on 2493 kidneys. Analyses showed significantly more donation after circulatory death, preemptive transplantation, and retransplants in the project cohort. Of the 681 kidneys that were transplanted during the project, 81% were preserved by HMP. No kidneys were discarded due to HMP-related complications. DGF occurred in 38.2% of the project cohort versus 43.7% of the historical cohort (P < 0.001), with a significantly shorter duration within the project cohort (7 versus 9 d, P = 0.003). Multivariate regression analysis showed an odds ratio of 0.69 (95% confidence interval, 0.553-0.855) for the risk of DGF when using HMP compared with cold storage (P = 0.001). There was no significant difference in kidney function, graft survival, and recipient survival up until 2 y posttransplantation. Conclusions. This study showed that HMP as a standard preservation method for deceased donor kidneys is safe and feasible. HMP was associated with a significant reduction of DGF.

AB - Background. Recently, continuous nonoxygenated hypothermic machine perfusion (HMP) has been implemented as standard preservation method for deceased donor kidneys in the Netherlands. This study was designed to assess the effect of the implementation of HMP on early outcomes after transplantation. Methods. Kidneys donated in the Netherlands in 2016 and 2017 were intended to be preserved by HMP. A historical cohort (2010-2014) preserved by static cold storage was chosen as the control group. Primary outcome was delayed graft function (DGF). Additional analyses were performed on safety, graft function, and survival up until 2 y after transplantation. Results. Data were collected on 2493 kidneys. Analyses showed significantly more donation after circulatory death, preemptive transplantation, and retransplants in the project cohort. Of the 681 kidneys that were transplanted during the project, 81% were preserved by HMP. No kidneys were discarded due to HMP-related complications. DGF occurred in 38.2% of the project cohort versus 43.7% of the historical cohort (P < 0.001), with a significantly shorter duration within the project cohort (7 versus 9 d, P = 0.003). Multivariate regression analysis showed an odds ratio of 0.69 (95% confidence interval, 0.553-0.855) for the risk of DGF when using HMP compared with cold storage (P = 0.001). There was no significant difference in kidney function, graft survival, and recipient survival up until 2 y posttransplantation. Conclusions. This study showed that HMP as a standard preservation method for deceased donor kidneys is safe and feasible. HMP was associated with a significant reduction of DGF.

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U2 - 10.1097/TP.0000000000003845

DO - 10.1097/TP.0000000000003845

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C2 - 34172648

AN - SCOPUS:85129778533

SN - 0041-1337

VL - 106

SP - 1043

EP - 1050

JO - Transplantation

JF - Transplantation

IS - 5

ER -

Hypothermic Machine Perfusion as a National Standard Preservation Method for Deceased Donor Kidneys

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