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Hypothermic machine perfusion is superior to static cold storage in deceased donor kidney transplantation: A meta-analysis

Lookup NU author(s): Dr Sam Tingle, Rodrigo Figueiredo, John Moir, Professor Michael Goodfellow, Dr Emily Thompson, Dr Ibrahim Ibrahim, Lucy Bates, David Talbot, Colin Wilson

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Abstract

© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons LtdBackground: There remains a lack of consensus on the optimal storage method for deceased donor kidneys. This meta-analysis compares storage with hypothermic machine perfusion (HMP) vs traditional static cold storage (SCS). Methods: The Cochrane Kidney and Transplant Specialised Register was searched to identify (quasi-) randomized controlled trials (RCTs) to include in our meta-analysis. PRISMA guidelines were used to perform and write this review. Results: There is high-certainty evidence that HMP reduces the risk of delayed graft function (DGF) when compared to SCS (2138 participants from 14 studies, RR = 0.77; 0.67-0.90, P =.0006). This benefit is significant in both donation following circulatory death (DCD; 772 patients from seven studies, RR = 0.75; 0.64-0.87, P =.0002) and donation following brainstem death (DBD) grafts (971 patients from four studies, RR = 0.78; 0.65-0.93, P =.006). The number of perfusions required to prevent one episode of DGF was 7.26 and 13.60 in DCD and DBD grafts, respectively. There is strong evidence that HMP also improves graft survival in both DBD and DCD grafts, at both 1 and 3 years. Economic analyses suggest HMP is cost-saving at 1 year compared with SCS. Conclusion: Hypothermic machine perfusion is superior to SCS in deceased donor renal transplantation. Direct comparisons with normothermic machine perfusion in RCTs are essential to identify optimal preservation methods in kidney transplantation.


Publication metadata

Author(s): Tingle SJ, Figueiredo RS, Moir JAG, Goodfellow M, Thompson ER, Ibrahim IK, Bates L, Talbot D, Wilson CH

Publication type: Review

Publication status: Published

Journal: Clinical Transplantation

Year: 2020

Issue: ePub ahead of Print

Online publication date: 07/02/2020

Acceptance date: 03/02/2020

ISSN (print): 0902-0063

ISSN (electronic): 1399-0012

Publisher: Blackwell Publishing Ltd

URL: https://doi.org/10.1111/ctr.13814

DOI: 10.1111/ctr.13814

PubMed id: 32031711


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