ORGAN DONATION AND ALLOCATION II

J. Sageshima¹, G. Ciancio¹, J. Sageshima¹, L. Scopesi¹, C. Lombardo¹, L. Chen¹, J.J. Gaynor¹, R. Brown¹, D.A. Grant², S. Ganz², G.W. Burke, iii^1
1Surgery, Kidney/pancreas Transplant, University of Miami Miller School of Medicine, Miami/UNITED STATES OF AMERICA, ²Miller School Of Medicine, University of Miami, Miami/UNITED STATES OF AMERICA

Body: Introduction: With the increased number of kidneys recovered from marginal donors (e.g. ECD and DCD), machine perfusion preservation (PP) draws more attention. While perfusion parameters (i.e.renal flow and resistance) are commonly used to assess the quality of kidneys, their changes over time and significance in predicting transplant outcomes are unclear.
Methods: We retrospectively assess the PP parameter changes of 183 kidney grafts recovered from ECD, DCD, and donors with poor renal function or adverse history in a single OPO (Nov. 2004— Dec. 2007). Transplant outcomes were compared by 4-hour perfusion parameters in single and double kidney transplantations separately.
Results: Overall, rapid improvement of renal flow and resistance was observed during the initial 12-hour period, with subsequent gradual improvement. When stratified to quartile by renal flowor resistance at 1 hour post-perfusion, more significant improvement was observed in kidneys with poor initial parameters (Figure).

Transplant outcome data were available from 42 single and 44 double kidney transplantations. Median cold ischemia time was 33 hours (range: 7 — 51). When grafts with high-flow (≥ 50mL/min/100g) at 4-hour perfusion were compared with grafts with low-flow (< 50 mL/min/100g), there were no differences in the incidence of DGF (single: 6.7% vs. 15.4%; double: 11.1% vs. 7.7%),1-year estimated GFR (single: 48.7 ± 11.8 vs. 57.1 ± 21.7, p = 0.117; double: 56.3 ± 15.4 vs. 60.0 ± 18.8, p = 0.956), and 3-year graft survival (single: 87.1% vs. 84.6%,p = 0.874; double: 94.1% vs. 92.3%, p = 0.633). Twenty-three grafts were discarded after PP based on donor demographics, history, renal function, biopsy results, and PP parameters, but the overall PPparameters of the discarded grafts were similar to those of transplanted grafts.
Conclusion: PP parameters can continue to improve over 12 hours and beyond for the kidneys recovered from marginal donors. Early PP parameters (at 4 hours) may not predict transplant outcomes.Although large-scale studies are required, poor initial PP parameters alone should not exclude kidney grafts from transplant.

Disclosure: All authors have declared no conflicts of interest.