[en] Background. In the Eurotransplant Senior Programme
(ESP), kidneys from donors aged ≥65 years are preferentially
allocated locally and transplanted into patients aged
≥65 years on dialysis. The purpose of this study was to
analyse whether the results of transplantation in the ESP
can be improved by preservation of organs by hypothermic
machine perfusion (MP) compared with simple cold
storage (CS).
Methods. Overall, 85 deceased heart-beating donors ≥65
years of age were included in this analysis with follow-up
until 1 year post-transplant. For each donor, one kidney
was randomly assigned to preservation by CS and the
contralateral kidney to MP from organ procurement until
transplantation. Delayed graft function (DGF), primary
non-function (PNF) and 1-year patient and graft survival
rates were evaluated as primary and secondary endpoints.
Results. The median recipient age was 66 years in both
groups and the median cold ischaemia time was 11 h for
MP and 10.5 h for CS (P = 0.69). The DGF rate was
29.4% for MP and 34.1% for CS (P = 0.58). Only extended
duration of cold ischaemia time was an independent risk
factor for the development of DGF (odds ratio 1.2, P <
0.0001). PNF was significantly reduced (3.5% MP versus
12.9% CS, P = 0.02). The 1-year patient and graft survival
rates were similar for MP and CS (94% versus 95% and 89
versus 81%, P > 0.05). The 1-year graft survival rate was
significantly improved after MP in recipients who developed
DGF (84% MP versus 48% CS, P = 0.01).
Conclusions. Continuous pulsatile hypothermic MP for
kidneys from donors aged ≥65 years can reduce the rate of
never-functioning kidneys and improve the 1-year graft
survival rate of kidneys with DGF. In this small cohort, the
known advantage of MP for the reduction of DGF could
not be confirmed, possibly due to relatively short cold
ischaemia times.
Disciplines :
Surgery
Author, co-author :
GALLINAT, Anja
MOERS, Cyril
TRECKMANN, Jürgen
M.SMITS, Jacqueline
LEUVENINK, Henry G.D
LEFERING, Rolf
van Heurn, Ernest
R.KIRSTE, Günter
SQUIFFLET, Jean-Paul ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
Smits JM, Persijn GG, van Houwelingen HC, Claas FH, Frei U. Evaluation of the Eurotransplant Senior Program. The results of the first year. Am J Transplant 2002; 2: 664-670.
ET-Manual, Vol. 4, Version 1.8, 2011, p. 14. www.eurotransplant.nl.
Frei U, Noeldeke J, Machold-Fabrizii V et al. Prospective age matching in elderly kidney transplant recipients a 5-year analysis of the Eurotransplant senior program. Am J Transplant 2008; 8: 50-57.
Moers C, Kornmann NS, Leuvenink HG et al. The influence of deceased donor age and old-for-old allocation on kidney transplant outcome. Transplantation 2009; 88: 542-552.
Ojo AO, Hanson JA, Meier-Kriesche H et al. Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol 2001; 12: 589-597.
Belzer FO, Kountz SL. Preservation and transplantation of human cadaver kidneys. A two-year experience. Ann Surg 1970; 172: 394-404.
Wight JP, Chilcott JB, Holmes MW et al. Pulsatile machine perfusion versus cold storage of kidneys for transplantation: a rapid and systematic review. Clin Transplant 2003; 17: 293-307.
Moers C, Smits JM, Maathuis MH et al. Machine perfusion or cold storage in deceased-donor kidney transplantation. N Engl J Med 2009; 360: 7-19.
Treckmann J, Moers C, Smits JM et al. Machine perfusion versus cold storage for preservation of kidneys from expanded criteria donors after brain death. Transpl Int 2011; 24: 548-554.
Jochmans I, Moers C, Smits JM et al. Machine perfusion versus cold storage for the preservation of kidneys donated after cardiac death: a multicenter, randomized, controlled trial. Ann Surg 2010; 252: 756-764.
Hetzel GR, Klein B, Brause M et al. Risk factors for delayed graft function after renal transplantation and their significance for longterm clinical outcome. Transpl Int 2002; 15: 10-16.
Ruggenenti P, Perico N, Remuzzi G. Ways to boost kidney transplant viability: a real need for the best use of older donors. Am J Transplant 2006; 6: 2543-2547.
Kahu J, Kyllönen L, Räisänen-Sokolowski A et al. Donor risk score and baseline biopsy CADI value predict kidney graft outcome. Clin Transplant 2011; 25: 276-283.
Moers C, Jochmans I, Treckmann J et al. Better graft survival with machine perfusion than cold storage after three years: Follow up analysis of the European multicentre RCT in deceased-donor kidney transplantation. Transpl Int 2011; 24 (S2): 93.
Giessing M, Fuller TF, Friedersdorff F et al. Outcomes of transplanting deceased-donor kidneys between elderly donors and recipients. J Am Soc Nephrol 2009; 20: 37-40.
Bodingbauer M, Pakrah B, Steininger R et al. The advantage of allocating kidneys from old cadaveric donors to old recipients: a single-center experience. Clin Transplant 2006; 20: 471-475.
Matsuoka L, Shah T, Aswad S et al. Pulsatile perfusion reduces the incidence of delayed graft function in expanded criteria donor kidney transplantation. Am J Transplant 2006; 6: 1473-1478.
Stratta RJ, Moore PS, Farney AC et al. Influence of pulsatile perfusion preservation on outcomes in kidney transplantation from expanded criteria donors. J Am Coll Surg 2007; 204: 873-882.
Schold JD, Kaplan B, Howard RJ et al. Are we frozen in time? Analysis of the utilization and efficacy of pulsatile perfusion in renal transplantation. Am J Transplant 2005; 5: 1681-1688.
Cecka JM, Cohen B, Rosendale J et al. Could more effective use of kidneys recovered from older deceased donors result in more kidney transplants for older patients? Transplantation 2006; 81: 966-970.
Cho YW, Shah T, Cho ES et al. Factors associated with discard of recovered kidneys. Transplant Proc 2008; 40: 1032-1034.
Polyak M, Boykin J, Arrington B et al. Pulsatile preservation characteristics predict early graft function in extended criteria donor kidneys. Transplant Proc 1997; 29: 3582-3583.
Sung RS, Christensen LL, Leichtman AB et al. Determinants of discard of expanded criteria donor kidneys: impact of biopsy and machine perfusion. Am J Transplant 2008; 8: 783-792.
Tullius SG, Milford E. Kidney allocation and the aging immune response. N Engl J Med 2011; 364: 1369-1370.
Fritsche L, Hörstrup J, Budde K et al. Old-for-old kidney allocation allows successful expansion of the donor and recipient pool. Am J Transplant 2003; 3: 1434-1439.
de Fijter JW. An old virtue to improve senior programs. Transpl Int 2009; 22: 259-268.
Yuan X, Theruvath AJ, Ge X et al. Machine perfusion or cold storage in organ transplantation: indication, mechanisms, and future perspectives. Transpl Int 2010; 23: 561-570.
Bentas W, Jones J, Karaoguz A et al. Renal transplantation in the elderly: surgical complications and outcome with special emphasis on the Eurotransplant Senior Programme. Nephrol Dial Transplant 2008; 23: 2043-2051.
Fabrizii V, Kovarik J, Bodingbauer M et al. Long-term patient and graft survival in the Eurotransplant Senior Program: a single-center experience. Transplantation 2005; 80: 582-589.