Normothermic machine perfusion is a feasible preservation technique and a promising strategy for donor kidneys in the Eurotransplant Senior Program (ESP)

E. Rijkse, J.J. de Jonge, H.J.A.N. Kimenai, M. Hoogduijn, R.W.F. de Bruin, M.W.F. van den Hoogen, J.N.M. IJzermans, R.C. Minnee

Wednesday 4 march 2020

14:10 - 14:20h at Theaterzaal

Parallel session: Parallel sessie III – Klinische abstracts

Background: Due to suboptimal quality of elderly donor kidneys transplanted in the Eurotransplant Senior Program (ESP), graft outcomes have shown to be inferior. Recently, normothermic machine perfusion (NMP) was identified as a preservation method to optimize marginal donor kidneys. Therefore, as first center in the Netherlands, we aimed to investigate the safety of implementing NMP in the ESP population to improve graft outcomes.

Methods: In 2018, ESP patients awaiting deceased donor kidney transplantation were prospectively asked to participate in a pilot study. Before implantation, the donor kidney was placed on 2 hours NMP at 37°C with a blood-based perfusate. Flow, intrarenal resistance and pressure during NMP were continuously measured. Biopsies, perfusate and urine samples were collected to assess markers of injury. Our primary outcome was to identify logistic challenges during NMP. As secondary outcomes, we assessed clinical outcomes such as the incidence of delayed graft function (DGF) or primary non function (PNF), 3 and 6 months eGFR, and biopsy proven acute rejection (BPAR) within 3 months. Clinical outcomes were compared to a historical cohort of ESP controls. Linear regression analysis was used to investigate differences in perfusion parameters during NMP between donor kidneys who developed DGF/PNF and donor kidneys with immediate function.

Results: 11 patients were included in the NMP group and 54 were used as historical controls. There were no logistic problems during NMP. Baseline characeristics were statistically similar. The incidence of DGF/PNF was lower in the NMP group, but this was not statistically different (NMP group: 36.4%, controls: 63%, p=0.10). BPAR within 3 months was similar. No significant difference was shown for 3 months eGFR (NMP: 31 (IQR 17), controls: 29 (IQR 18.3), p=0.50) and 6 months eGFR (NMP: 31 (IQR 14), controls: 30 (IQR 17.3), p=0.97). 1-year graft survival was 0.89 ±0.11 in the NMP group and 0.85 ±0.05 in the control group (log-rank test 0.62). Linear regression analysis showed a significantly higher increase in flow during NMP for kidneys with immediate function compared to DGF kidneys (No DGF: y=108.3 ± 1.18, DGF: y=106.6 ± 0.70, p=0.01).

Conclusions: Two hours of NMP is safe and feasible in the ESP. No statistical significant differences could be found for clinical outcomes in this small sample size. Flow during NMP could give an indication of the chance of immediate function in the recipient. Well-powered studies are needed to validate our results.