Elsevier

Transplantation Proceedings

Volume 37, Issue 1, January–February 2005, Pages 350-351
Transplantation Proceedings

Use of perfusion parameters in predicting outcomes of machine-preserved kidneys

https://doi.org/10.1016/j.transproceed.2005.01.058Get rights and content

Abstract

Perfusion parameters (PP) and early transplant outcome data from 332 consecutive ECD type kidneys machine preserved on the Waters RM-3 apparatus were reviewed and analyzed to examine the validity of using suboptimal PPs (renal resistance of .41–.60) as a criterion for discarding kidneys. Overall discard rate was 23.5%, with 55% of these having “poor” PP as part of reason for discard. PP analysis after 4 hours on the RM-3 is presented. This encompasses 280 kidneys with renal resistance ≤ .60. Sixty-six kidneys were discarded (23.5%). Of the 214 transplanted kidneys, 146 had immediate function (IF; 68%), 63 had delayed function (DGF; 29%), and 5 never functioned (PNF; 2%). Of the 30 transplanted kidneys with renal resistance .40 to .60, 16 (53%) had IF versus 58% in kidneys with renal resistance ≤ .40 (P = .125). Two of the five PNF kidney had renal resistance > .40. The PP-related discard rate in the renal resistance .41 to .60 kidneys was 51% versus 17% in the renal resistance ≤ .40 (P ≤ .01). Based on our observations kidneys with renal resistance ≤ .60 should not be discarded strictly based on “suboptimal perfusion parameters.” This presents an opportunity for a decrease in discard rates of ECD kidneys.

Section snippets

Materials and methods

Data were analyzed from 332 consecutive kidneys machine preserved on the Waters RM-3 apparatus using Belzer-MP perfusate during January 2002 to July 2004. Criteria for machine perfusion at our center were: age ≥60 or age 50 to 59 with minimum one of the following: HTN, diabetes, admission serum creatinine ≥ 1.5, estimated GFR <70 mL/min, or doubling of serum creatinine (admit to last), and kidneys donated after cardiac death. Pump pressures were set at 60 mm Hg and allowed to decrease. Renal

Results

During the study period, 1356 kidneys were procured, of which 332 were preserved by pulsatile hypothermic perfusion using the Waters apparatus. Overall, 254 kidneys were transplanted with an immediate function rate of 65%. Seventy-eight kidneys were discarded (23.5%) with 43 of these having “poor perfusion parameters” as part of the reason for discard. Thirty-nine kidneys were removed from the pump in less than 4 hours—28 were transplanted and 11 were discarded. In 6 of the 11 discards “poor”

Discussion

Machine perfusion of deceased donor kidneys in the United States has regained wider acceptance in recent years, with the increasing kidney recovery from the extended criteria donor and increasing frequency of donation after cardiac death. The percentage of extended criteria donor kidneys increased nationally from 21.2% in 2002 to 26.4% in 2003.1 We use machine perfusion for all extended criteria donor kidneys and all kidneys retreived from donors after cardiac death. Our overall kidney discard

Acknowledgments

The authors gratefully acknowledge the excellent assistance of Ms. Gwendolyn Blakemore in the management of the renal perfusion database utilized in this report.

References (3)

  • OPTN/SRTR data, presented to UNOS Organ Availability Committee, 2004 (unpublished...
There are more references available in the full text version of this article.

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