Favorable outcomes with machine perfusion and longer pump times in kidney transplantation: A single-center, observational study

Gaetano Ciancio, Jeffrey J. Gaynor, Junichiro Sageshima, Linda Chen, David Roth, Warren Kupin, Giselle Guerra, Lissett Tueros, Alberto Zarak, Lois Hanson, Susan Ganz, Phillip Ruiz, William W. O'Neill, Alan S. Livingstone, George W. Burke

Research output: Contribution to journalArticle

33 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)882-890
Number of pages9
JournalTransplantation
Volume90
Issue number8
DOIs
StatePublished - Oct 27 2010
Externally publishedYes

Fingerprint

Infusion Pumps
Delayed Graft Function
Kidney Transplantation
Observational Studies
Perfusion
Transplants
Kidney
Biopsy
Immunosuppression
Tissue Donors
Graft Rejection
Dialysis
Logistic Models
Regression Analysis

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 journalArticle

Ciancio, G, Gaynor, JJ, Sageshima, J, Chen, L, Roth, D, Kupin, W, Guerra, G, Tueros, L, Zarak, A, Hanson, L, Ganz, S, Ruiz, P, O'Neill, WW, Livingstone, AS & Burke, GW 2010, 'Favorable outcomes with machine perfusion and longer pump times in kidney transplantation: A single-center, observational study', Transplantation, vol. 90, no. 8, pp. 882-890. https://doi.org/10.1097/TP.0b013e3181f2c962
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. / Favorable outcomes with machine perfusion and longer pump times in kidney transplantation : A single-center, observational study. In: Transplantation. 2010 ; Vol. 90, No. 8. pp. 882-890.
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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.

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KW - Delayed graft function

KW - Duration of machine perfusion (pump) time

KW - Graft failure

KW - Kidney transplantation

KW - Machine perfusion

KW - Static cold storage

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