Detailed Abstract
[E-poster - Liver (Transplantation)]
[EP 044] Randomized Controlled Trials of Ex Vivo Kidney Machine Perfusion: an Updated Systematic Review And Meta-analysis
Minseok KANG 1, Seonju KIM 1, Ji Yoon CHOI 1, Kyeong Sik KIM 1, Yun Kyung JUNG 1, Boyoung PARK 1, Dongho CHOI 1
1 Surgery, Hanyang University Medical Center, REPUBLIC OF KOREA
Background : Machine perfusion is a novel organ preservation strategy. This article presents an updated systematic review and meta-analysis of machine perfusion in deceased donor kidneys.
Methods : Randomized controlled trials (RCTs) from November 2018 to July 2023 comparing machine perfusion versus static cold storage (SCS) in kidney transplantation were updated for systematic review. The primary outcome in meta-analysis was delayed graft function (DGF).
Results : A total of 19 studies were included, and meta-analysis was performed for 16 studies comparing continuous nonoxygenated hypothermic machine perfusion (CN-HMP) (1,630 kidneys) versus SCS (1,480 kidneys). The overall risk of DGF was lower with CN-HMP than with SCS (risk ratio (RR) 0.75, confidence interval (CI) 0.68 to 0.82). CN-HMP decreased the risk of DGF in donor kidneys of donation after circulatory death (RR 0.78, CI 0.67 to 0.90) and donation after brain death (RR 0.73, CI 0.63 to 0.84), modern era (RR 0.74, CI 0.65 to 0.83) and pre-2008 (RR 0.75, CI 0.65 to 0.91) studies, short (<24h) (RR 0.82, CI 0.69 to 0.97) and long (≥24h) (RR 0.69, CI 0.57 to 0.83) mean cold ischemic time (CIT). Two RCTs were reviewed. 1h normothermic machine perfusion (NMP) after SCS and short-term oxygenated hypothermic machine perfusion preservation (end-HMPo2) after SCS was equivalent to SCS in terms of DGF and one-year graft survival, respectively.
Conclusions : CN-HMP preserved kidneys have lower rates of DGF irrespective of the donor type, CIT, and era of study. Novel approaches including NMP and end-HMPo2 seems safe and promising.
Methods : Randomized controlled trials (RCTs) from November 2018 to July 2023 comparing machine perfusion versus static cold storage (SCS) in kidney transplantation were updated for systematic review. The primary outcome in meta-analysis was delayed graft function (DGF).
Results : A total of 19 studies were included, and meta-analysis was performed for 16 studies comparing continuous nonoxygenated hypothermic machine perfusion (CN-HMP) (1,630 kidneys) versus SCS (1,480 kidneys). The overall risk of DGF was lower with CN-HMP than with SCS (risk ratio (RR) 0.75, confidence interval (CI) 0.68 to 0.82). CN-HMP decreased the risk of DGF in donor kidneys of donation after circulatory death (RR 0.78, CI 0.67 to 0.90) and donation after brain death (RR 0.73, CI 0.63 to 0.84), modern era (RR 0.74, CI 0.65 to 0.83) and pre-2008 (RR 0.75, CI 0.65 to 0.91) studies, short (<24h) (RR 0.82, CI 0.69 to 0.97) and long (≥24h) (RR 0.69, CI 0.57 to 0.83) mean cold ischemic time (CIT). Two RCTs were reviewed. 1h normothermic machine perfusion (NMP) after SCS and short-term oxygenated hypothermic machine perfusion preservation (end-HMPo2) after SCS was equivalent to SCS in terms of DGF and one-year graft survival, respectively.
Conclusions : CN-HMP preserved kidneys have lower rates of DGF irrespective of the donor type, CIT, and era of study. Novel approaches including NMP and end-HMPo2 seems safe and promising.
SESSION
E-poster
E-Session 03/21 ALL DAY