Hypothermic Machine Perfusion During Extended Cold Ischemic Times - An Opportunity To Improve Pathways of Care in Cadaveric Renal Transplantation.

Purpose The logistics of cadaveric renal transplantation are largely driven by Cold Ischemic Time (CIT). However, to achieve successful outcomes in increasingly complex donor-recipient combinations, recipient and operative issues demand equal consideration. Extending CIT without detriment to graft function would therefore be of value. We have investigated the role of Hypothermic Machine Perfusion (HMP) as a tool by which such an extension might be obtained. Methods Cadaveric kidneys were allocated to a storage method depending on predicted time to theatre. Kidneys to be transplanted between 8am-8pm in the dedicated transplant theatre remained in Static Cold Storage (SCS). If predicted operating time was out-of-hours, the kidney was transferred to HMP and transplanted at the earliest opportunity on the elective transplant list. Data were collected prospectively including donor and recipient demographics, CIT, operative factors and post-transplant outcomes. Results During the study period (Jan 2012-Dec 2013 inclusive) 74 kidneys were transplanted from HMP and 101 from SCS. Median CIT was 23.85 hours in the HMP group compared to 13 hours in the SCS group (p=<0.0001). 20 HMP kidneys suffered from DGF (27%) compared to 47 (47%) in the SCS group (p=0.012). For DBD kidneys only, 15 of the 65 (23%) HMP kidneys developed DGF compared to 30 of the 75 (40%) SCS kidneys (p=0.046). DGF rates were equivalent for the small number of DCD kidneys in the study. There were no other significant differences in graft or post-operative complications. Conclusions This study demonstrates that improved early graft outcomes can be achieved following longer CITs by utilising HMP storage rather than traditional SCS. This effect is likely to be multi-factorial; including improved recipient preparation, better peri-operative conditions and the inherent effects of HMP itself. Preferences§1234567890-=Backspace Tabqwertyuiop[] Return capslockasdfghjkl;' shift'zxcvbnm,./shift English Deutsch Español Français Italiano Português PyCCKNN alt alt Preferences DISCLOSURES:Guy, A.: Grant/Research Support, Organ Recovery Systems. Inston, N.: Grant/Research Support, Organ Recovery Systems. Ready, A.: Grant/Research Support, Organ Recovery Systems.