Optimizing kidney preservation with machine perfusion - A comparison between warm and hypothermic machine perfusion of donor kidneys: A systematic review and meta-analysis

Ö Eryigit, J. de Jonge, M.J. Hoogduijn, M.W.F. van den Hoogen, R.W.F. de Bruin, J.N.M. IJzermans, R.C. Minnee

Thursday 15 march 2018

15:40 - 15:45h at Willem Burger Foyer

Categories: Clinical, Session (poster)

Parallel session: Poster session 2: Clinical

Background

In the Netherlands, 50% of deceased donor kidney offers are after circulatory death (DCD). Since 2015, all donor kidneys are preserved on hypothermic machine perfusion. However, these deceased donors are becoming older and are transplanted in older recipients with more comorbidity. To keep suboptimal donor kidneys on an equal quality level, new preservation methods are necessary. Normothermic machine perfusion is a new alternative for kidney preservation. A systematic review and meta-analysis was conducted to compare warm machine perfusion to hypothermic machine perfusion of donor kidneys.

Methods

We conducted a literature search on Embase, Medline Epub (Ovid), Cochrane Central, Web of Science, and Google scholar for studies comparing warm machine perfusion (WMP = normothermic (NMP) and subnormothermic machine perfusion (SNMP)) to hypothermic machine perfusion (HMP) of donor kidneys. Two independent reviewers assessed the eligibility of each study. Meta-analyses were performed to calculate the overall effect size of peak creatinine clearance, peak serum creatinine, and recipient survival.

Results

Of 938 records found, 11 animal studies were eligible for qualitative synthesis of which 8 studies had appropriate data for the meta-analyses. Peak serum creatinine was significantly lower in kidneys preserved with WMP (standardized mean difference (SMD): -2.56 (95% CI, -4.22 to -0.89) and WMP was protective on recipient survival with significantly less graft losses in animals which received donor kidneys (RR: 0.33 (95% CI, 0.15 to 0.71) using the random-effects model. There was no difference in peak creatinine clearance between both groups (SMD: 1.64 (95% CI, -0.72 to 4.00).

Conclusions

WMP may lead to better short-term post-transplant graft outcomes than HMP. The advantages of normothermic machine perfusion in the long term need to be assessed in future clinical trials.