Abstract :
[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.
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