Randomized Trial of Machine Perfusion Versus Cold Storage in Recipients of Deceased Donor Kidney Transplants With High Incidence of Delayed Graft Function

• Autor(a) principal: Tedesco-Silva Junior, Helio
• Data de Publicação: 2017
• Outros Autores: Mello Offerni, Juliano Chrystian, Carneiro, Vanessa Ayres, Paula, Mayara Ivani de, David Neto, Elias, Carvalhinho Lemos, Francine Brambate, Requiao Moura, Lucio Roberto, Pacheco e Silva Filho, Alvaro, Morais Cunha, Mirian de Fatima de, Silva, Erica Francisco da, Miorin, Luiz Antonio, Demetrio, Daniela Priscila, Luconi, Paulo Sergio, Silva Luconi, Waldere Tania da, Bobbio, Savina Adriana, Kuschnaroff, Liz Milstein, Noronha, Irene Lourdes, Braga, Sibele Lessa, Barsante, Renata Cristina, Mendes Moreira, Joao Cezar, Maximina Fernandes-Charpiot, Ida Maria, Abbud-Filho, Mario, Modelli de Andrade, Luis Gustavo [UNESP], Garcia, Paula Dalsoglio [UNESP], Santamaria Saber, Luciana Tanajura, Laurindo, Alan Fernandes, Chocair, Pedro Renato, Cuvello Neto, Americo Lourenco, Zanocco, Juliana Aparecida, Soares Filho, Antonio Jose Duboc de Almeida, Aguiar, Wilson Ferreira, Pestana, Jose Medina
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UNESP
• Texto Completo: http://dx.doi.org/10.1097/TXD.0000000000000672; http://hdl.handle.net/11449/162858

Background. This study compared the use of static cold storage versus continuous hypothermic machine perfusion in a cohort of kidney transplant recipients at high risk for delayed graft function (DGF). Methods. In this national, multicenter, and controlled trial, 80 pairs of kidneys recovered from brain-dead deceased donors were randomized to cold storage or machine perfusion, transplanted, and followed up for 12 months. The primary endpoint was the incidence of DGF. Secondary endpoints included the duration of DGF, hospital stay, primary nonfunction, estimated glomerular filtration rate, acute rejection, and allograft and patient survivals. Results. Mean cold ischemia time was high but not different between the 2 groups (25.6 +/- 6.6 hours vs 25.05 +/- 6.3 hours, 0.937). The incidence of DGF was lower in the machine perfusion compared with cold storage group (61% vs. 45%, P = 0.031). Machine perfusion was independently associated with a reduced risk of DGF (odds ratio, 0.49; 95% confidence interval, 0.26-0.95). Mean estimated glomerular filtration rate tended to be higher at day 28 (40.6 +/- 19.9 mL/min per 1.73 m(2) vs 49.0 +/- 26.9 mL/min per 1.73 m(2); P = 0.262) and 1 year (48.3 +/- 19.8 mL/min per 1.73 m(2) vs 54.4 +/- 28.6 mL/min per 1.73 m(2); P = 0.201) in the machine perfusion group. No differences in the incidence of acute rejection, primary nonfunction (0% vs 2.5%), graft loss (7.5% vs 10%), or death (8.8% vs 6.3%) were observed. Conclusions. In this cohort of recipients of deceased donor kidneys with high mean cold ischemia time and high incidence of DGF, the use of continuous machine perfusion was associated with a reduced risk of DGF compared with the traditional cold storage preservation method.