Abstract
Background.: Hypothermic machine perfusion (MP) preservation is used for all deceased donor kidney transplants at our center. Kidneys are placed in cold storage at retrieval, then transferred to MP on arrival. Because a lack of consensus regarding optimal use of MP still exists, we evaluated the overall impact of using MP at our center and the prognostic value of MP (Pump) time. Methods.: We retrospectively analyzed 339 adult, primary deceased donor kidney transplant recipients who were pooled across three prospective, randomized immunosuppression trials (since 2000) at our center. In addition to providing overall results for delayed graft function (DGF) (requirement for dialysis in the first week), slow graft function (SGF), first biopsy-proven acute rejection (BPAR), and graft failure, stepwise logistic and Cox regression analyses were used to determine the prognostic value of pump time, particularly after controlling for other significant prognosticators. Results.: Mean cold storage and pump times were 6.6 and 26.7 hr, consistent across immunosuppression protocols. Overall DGF and SGF rates were 4.4% (15/339) and 12.1% (41/339). DGF was equally low for pump time less than 24 vs. more than or equal to 24 hr, 5.2% (6/116) vs. 4.0% (9/223) (P=0.63), with similar results after adjusting for known DGF predictors. A significantly lower first BPAR rate was observed for longer pump time (as a continuous variable) among more immunologically active recipients (those having more risk factors: DGF, age <50 yr, and non-white) (univariable P=0.005; multivariable P=0.009), with an estimated hazard ratio of 0.43 (P=0.006) favoring pump time more than or equal to 24 hr among those with more than or equal to two risk factors. Conclusions.: In this single-center, observational study, MP with prolonged pump times was associated with low DGF/SGF and first BPAR rates, supporting continued use of MP.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 882-890 |
| Number of pages | 9 |
| Journal | Transplantation |
| Volume | 90 |
| Issue number | 8 |
| DOIs | |
| State | Published - Oct 27 2010 |
| Externally published | Yes |
Fingerprint
Keywords
- Biopsy-proven acute rejection
- Delayed graft function
- Duration of machine perfusion (pump) time
- Graft failure
- Kidney transplantation
- Machine perfusion
- Static cold storage
ASJC Scopus subject areas
- Transplantation
Cite this
Favorable outcomes with machine perfusion and longer pump times in kidney transplantation : A single-center, observational study. / Ciancio, Gaetano; Gaynor, Jeffrey J.; Sageshima, Junichiro; Chen, Linda; Roth, David; Kupin, Warren; Guerra, Giselle; Tueros, Lissett; Zarak, Alberto; Hanson, Lois; Ganz, Susan; Ruiz, Phillip; O'Neill, William W.; Livingstone, Alan S.; Burke, George W.
In: Transplantation, Vol. 90, No. 8, 27.10.2010, p. 882-890.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Favorable outcomes with machine perfusion and longer pump times in kidney transplantation
T2 - A single-center, observational study
AU - Ciancio, Gaetano
AU - Gaynor, Jeffrey J.
AU - Sageshima, Junichiro
AU - Chen, Linda
AU - Roth, David
AU - Kupin, Warren
AU - Guerra, Giselle
AU - Tueros, Lissett
AU - Zarak, Alberto
AU - Hanson, Lois
AU - Ganz, Susan
AU - Ruiz, Phillip
AU - O'Neill, William W.
AU - Livingstone, Alan S.
AU - Burke, George W.
PY - 2010/10/27
Y1 - 2010/10/27
N2 - Background.: Hypothermic machine perfusion (MP) preservation is used for all deceased donor kidney transplants at our center. Kidneys are placed in cold storage at retrieval, then transferred to MP on arrival. Because a lack of consensus regarding optimal use of MP still exists, we evaluated the overall impact of using MP at our center and the prognostic value of MP (Pump) time. Methods.: We retrospectively analyzed 339 adult, primary deceased donor kidney transplant recipients who were pooled across three prospective, randomized immunosuppression trials (since 2000) at our center. In addition to providing overall results for delayed graft function (DGF) (requirement for dialysis in the first week), slow graft function (SGF), first biopsy-proven acute rejection (BPAR), and graft failure, stepwise logistic and Cox regression analyses were used to determine the prognostic value of pump time, particularly after controlling for other significant prognosticators. Results.: Mean cold storage and pump times were 6.6 and 26.7 hr, consistent across immunosuppression protocols. Overall DGF and SGF rates were 4.4% (15/339) and 12.1% (41/339). DGF was equally low for pump time less than 24 vs. more than or equal to 24 hr, 5.2% (6/116) vs. 4.0% (9/223) (P=0.63), with similar results after adjusting for known DGF predictors. A significantly lower first BPAR rate was observed for longer pump time (as a continuous variable) among more immunologically active recipients (those having more risk factors: DGF, age <50 yr, and non-white) (univariable P=0.005; multivariable P=0.009), with an estimated hazard ratio of 0.43 (P=0.006) favoring pump time more than or equal to 24 hr among those with more than or equal to two risk factors. Conclusions.: In this single-center, observational study, MP with prolonged pump times was associated with low DGF/SGF and first BPAR rates, supporting continued use of MP.
AB - Background.: Hypothermic machine perfusion (MP) preservation is used for all deceased donor kidney transplants at our center. Kidneys are placed in cold storage at retrieval, then transferred to MP on arrival. Because a lack of consensus regarding optimal use of MP still exists, we evaluated the overall impact of using MP at our center and the prognostic value of MP (Pump) time. Methods.: We retrospectively analyzed 339 adult, primary deceased donor kidney transplant recipients who were pooled across three prospective, randomized immunosuppression trials (since 2000) at our center. In addition to providing overall results for delayed graft function (DGF) (requirement for dialysis in the first week), slow graft function (SGF), first biopsy-proven acute rejection (BPAR), and graft failure, stepwise logistic and Cox regression analyses were used to determine the prognostic value of pump time, particularly after controlling for other significant prognosticators. Results.: Mean cold storage and pump times were 6.6 and 26.7 hr, consistent across immunosuppression protocols. Overall DGF and SGF rates were 4.4% (15/339) and 12.1% (41/339). DGF was equally low for pump time less than 24 vs. more than or equal to 24 hr, 5.2% (6/116) vs. 4.0% (9/223) (P=0.63), with similar results after adjusting for known DGF predictors. A significantly lower first BPAR rate was observed for longer pump time (as a continuous variable) among more immunologically active recipients (those having more risk factors: DGF, age <50 yr, and non-white) (univariable P=0.005; multivariable P=0.009), with an estimated hazard ratio of 0.43 (P=0.006) favoring pump time more than or equal to 24 hr among those with more than or equal to two risk factors. Conclusions.: In this single-center, observational study, MP with prolonged pump times was associated with low DGF/SGF and first BPAR rates, supporting continued use of MP.
KW - Biopsy-proven acute rejection
KW - Delayed graft function
KW - Duration of machine perfusion (pump) time
KW - Graft failure
KW - Kidney transplantation
KW - Machine perfusion
KW - Static cold storage
UR - http://www.scopus.com/inward/record.url?scp=78349296703&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=78349296703&partnerID=8YFLogxK
U2 - 10.1097/TP.0b013e3181f2c962
DO - 10.1097/TP.0b013e3181f2c962
M3 - Article
C2 - 20703178
AN - SCOPUS:78349296703
VL - 90
SP - 882
EP - 890
JO - Transplantation
JF - Transplantation
SN - 0041-1337
IS - 8
ER -