Question Does preimplantation short-term reconditioning of kidney grafts using oxygenated
hypothermic machine perfusion for at least 2 hours after an initial period of static
cold storage lead to an improvement of 1-year graft survival in kidneys retrieved
from expanded criteria donors? Findings In this randomized clinical trial of 305 kidneys,
1-year graft survival was equal between kidneys that were machine perfused following
static cold storage and kidneys that remained on static cold storage prior to implantation
without oxygenated hypothermic machine perfusion. Meaning These findings suggest that
the use of oxygenated hypothermic machine perfusion prior to implantation and following
a period of static cold storage does not improve graft survival or kidney function
in kidneys retrieved from donors who are brain dead meeting the expanded donor criteria.
Importance Continuous hypothermic machine perfusion during organ preservation has
a beneficial effect on graft function and survival in kidney transplant when compared
with static cold storage (SCS). Objective To compare the effect of short-term oxygenated
hypothermic machine perfusion preservation (end-HMPo2) after SCS vs SCS alone on 1-year
graft survival in expanded criteria donor kidneys from donors who are brain dead.
Design, Setting, and Participants In a prospective, randomized, multicenter trial,
kidneys from expanded criteria donors were randomized to either SCS alone or SCS followed
by end-HMPo2 prior to implantation with a minimum machine perfusion time of 120 minutes.
Kidneys were randomized between January 2015 and May 2018, and analysis began May
2019. Analysis was intention to treat. Interventions On randomization and before implantation,
deceased donor kidneys were either kept on SCS or placed on HMPo2. Main Outcome and
Measures Primary end point was 1-year graft survival, with delayed graft function,
primary nonfunction, acute rejection, estimated glomerular filtration rate, and patient
survival as secondary end points. Results Centers in 5 European countries randomized
305 kidneys (median [range] donor age, 64 [50-84] years), of which 262 kidneys (127
[48.5%] in the end-HMPo2 group vs 135 [51.5%] in the SCS group) were successfully
transplanted. Median (range) cold ischemia time was 13.2 (5.1-28.7) hours in the end-HMPo2
group and 12.9 (4-29.2) hours in the SCS group; median (range) duration in the end-HMPo2
group was 4.7 (0.8-17.1) hours. One-year graft survival was 92.1% (n = 117) in the
end-HMPo2 group vs 93.3% (n = 126) in the SCS group (95% CI, -7.5 to 5.1; P = .71).
The secondary end point analysis showed no significant between-group differences for
delayed graft function, primary nonfunction, estimated glomerular filtration rate,
and acute rejection. Conclusions and Relevance Reconditioning of expanded criteria
donor kidneys from donors who are brain dead using end-HMPo2 after SCS does not improve
graft survival or function compared with SCS alone. This study is underpowered owing
to the high overall graft survival rate, limiting interpretation. This randomized
clinical trial compares the effect of short-term oxygenated hypothermic machine perfusion
preservation after static cold storage vs static cold storage alone on 1-year graft
survival in expanded criteria donor kidneys from donors who are brain dead.
