Machine Perfusion or Cold Storage in Deceased-Donor Kidney TransplantationCyril Moers, M.D., Jacqueline M. Smits, M.D., Ph.D., Mark-Hugo J. Maathuis,

Cyril Moers, M.D., Jacqueline M. Smits, M.D., Ph.D., Mark-Hugo J. Maathuis, M.D., Ph.D., Jürgen Treckmann, M.D., Frank van Gelder, Bogdan P. Napieralski, Margitta van Kasterop-Kutz, Jaap J. Homan van der Heide, M.D., Ph.D., Jean-Paul Squifflet, M.D., Ph.D., Ernest van Heurn, M.D., Ph.D., Günter R. Kirste, M.D., Ph.D., Axel Rahmel, M.D., Ph.D., Henri G.D. Leuvenink, Ph.D., Andreas Paul, M.D., Ph.D., Jacques Pirenne, M.D., Ph.D., and Rutger J. Ploeg, M.D., Ph.D.

ABSTRACT

Background Static cold storage is generally used to preserve kidney allografts from deceased donors. Hypothermic machine perfusion may improve outcomes after transplantation, but few sufficiently powered prospective studies have addressed this possibility.

Methods In this international randomized, controlled trial, we randomly assigned one kidney from 336 consecutive deceased donors to machine perfusion and the other to cold storage. All 672 recipients were followed for 1 year. The primary end point was delayed graft function (requiring dialysis in the first week after transplantation). Secondary end points were the duration of delayed graft function, delayed graft function defined by the rate of the decrease in the serum creatinine level, primary nonfunction, the serum creatinine level and clearance, acute rejection, toxicity of the calcineurin inhibitor, the length of hospital stay, and allograft and patient survival.

Results Machine perfusion significantly reduced the risk of delayed graft function. Delayed graft function developed in 70 patients in the machine-perfusion group versus 89 in the cold-storage group (adjusted odds ratio, 0.57; P=0.01). Machine perfusion also significantly improved the rate of the decrease in the serum creatinine level and reduced the duration of delayed graft function. Machine perfusion was associated with lower serum creatinine levels during the first 2 weeks after transplantation and a reduced risk of graft failure (hazard ratio, 0.52; P=0.03). One-year allograft survival was superior in the machine-perfusion group (94% vs. 90%, P=0.04). No significant differences were observed for the other secondary end points. No serious adverse events were directly attributable to machine perfusion.

Conclusions Hypothermic machine perfusion was associated with a reduced risk of delayed graft function and improved graft survival in the first year after transplantation. (Current Controlled Trials number, ISRCTN83876362 [controlled-trials.com] .)