ONE-YEAR OUTCOME OF HMP(O2)-PERFUSED KIDNEYS AFTER THE IMPLEMENTATION OF A NATIONAL MACHINE PERFUSION SERVICE

Background: In October 2022, a national hypothermic machine perfusion
(HMP) service was implemented for all kidneys from expanded criteria donors
(ECD) and kidneys donated after circulatory death (DCD) procured and trans-
planted in Belgium. The aim of this study is to evaluate the functional one-year
outcome of these kidneys continuously perfused with HMP.
Methods: A retrospective analysis was performed on 242 HMP-perfused kidney
transplantations (DBD+DCD) performed between 1/10/2022 and 30/09/2023 of
which 49 from ECD (defined as a DBD donor between 50-60yrs old with 2/3
following criteria (arterial hypertension, serum creatinine>1.5mg/dl and death
due to cerebrovascular accident) or a donor> 60yrs) and 193 from DCD donors.
The LifePort Kidney Transporter (?Organ Recovery Systems) was used for all
MP procedures. Active oxygenation realized by preceding bubble O2 of the
perfusate and continuous surface O2 during HMP was applied to all DCD>50yrs
and in study context in 14 DCD≤50yrs$. Donor demographics and functional
outcome were analyzed.
Results: The 1-year functional outcome according to donor type is illustrated
in Table 1.
Donor type All
(ECD +DCD) DBD ECD DCD DCD≤50y DCD>50yrs
Type of kidney
preservation
(HMP, HMPO2)
HMP(O2)
(n=242)
HMP
(n=49)
HMP
(n=193)
HMP(O2)$
(n=77)
HMP(O2)
(n=116)
Delayed graft
function, % 14.35 9.14 16.67 9.46 19.64
Mean eGFR
@1y, ml/
min/1.73m2
54.25 52.03 54.69 61.10 49.73
Organ rejection
@1y, % 10.05 2.33 12.82 8.96 14.00
Death-censored
graft survival
@1y, %
96.28 100 94.34 97.40 93.97
Patient survival
@1y, % 98.34 95.91 98.96 100 98.28
The reasons for graft loss (13/242) were primary nonfunction (n=1), rejection
(n=1), donor-transmitted infection (n=1), graft infection (n=1), arterial throm-
bosis (n=1), venous thrombosis (n=2), unknown (n=2) and patient’s death (n=4).
Conclusions: Functional outcome of HMP-preserved kidneys after the intro-
duction of a national HMP program for all ECD and DCD kidneys is excellent
and reassures transplant teams in their decision-making process when such
higher-risk kidneys are offered for transplantation.