Machine perfusion versus cold storage of kidneys derived from donation after cardiac death: a meta-analysis

PLoS One. 2013;8(3):e56368. doi: 10.1371/journal.pone.0056368. Epub 2013 Mar 11.

Abstract

Background: In response to the increased organ shortage, organs derived from donation after cardiac death (DCD) donors are becoming an acceptable option once again for clinical use in transplantation. However, transplant outcomes in cases where DCD organs are used are not as favorable as those from donation after brain death or living donors. Different methods of organ preservation are a key factor that may influence the outcomes of DCD kidney transplantation.

Methods: We compared the transplant outcomes in patients receiving DCD kidneys preserved by machine perfusion (MP) or by static cold storage (CS) preservation by conducting a meta-analysis. The MEDLINE, EMBASE and Cochrane Library databases were searched. All studies reporting outcomes for MP versus CS preserved DCD kidneys were further considered for inclusion in this meta-analysis. Odds ratios and 95% confidence intervals (CI) were calculated to compare the pooled data between groups that were transplanted with kidneys that were preserved by MP or CS.

Results: Four prospective, randomized, controlled trials, involving 175 MP and 176 CS preserved DCD kidney transplant recipients, were included. MP preserved DCD kidney transplant recipients had a decreased incidence of delayed graft function (DGF) with an odd ration of 0.56 (95% CI = 0.36-0.86, P = 0.008) compared to CS. However, no significant differences were seen between the two technologies in incidence of primary non-function, one year graft survival, or one year patient survival.

Conclusions: MP preservation of DCD kidneys is superior to CS in terms of reducing DGF rate post-transplant. However, primary non-function, one year graft survival, and one year patient survival were not affected by the use of MP or CS for preservation.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cause of Death
  • Cryopreservation* / methods
  • Death
  • Graft Survival
  • Humans
  • Kidney Transplantation
  • Kidney*
  • Odds Ratio
  • Organ Preservation / methods*
  • Patient Outcome Assessment
  • Perfusion* / methods
  • Tissue Donors

Grant support

This study was supported by the National High Technology Research and Development Program of China (863 Program) (2012AA021008), the Key Clinical Project from the Ministry of Health (2010159), the National Natural Science Foundation of China (30972951, 81102244, 81102245, and 81170448), the Special Fund for Science Research by Ministry of Health (201002004), the Research Fund for the Doctoral Program of Higher Education of China by Ministry of Education (20100171110063 and 20110171120077), the Science and Technology Planning Key Clinical Project of Guangdong Province (2011A030400005), and Project by Division of Medical Service Management of Ministry of Health (2010), China. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.