Goulamhoussen N, Slapcoff L, Baran D, Boucher A, Houde I, Masse M, Albert M, Marsolais P, Cardinal H, Bouchard J. Factors Associated With the Use of Hypothermic Machine Perfusion in Kidney Transplant Recipients: A Multicenter Retrospective Cohort Study.
Can J Kidney Health Dis 2022;
9:20543581211048338. [PMID:
36062213 PMCID:
PMC9434662 DOI:
10.1177/20543581211048338]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background:
Delayed graft function (DGF) is associated with an increased risk of graft
loss. The use of cold hypothermic machine perfusion (HMP) has been shown to
reduce the incidence of DGF in kidney transplant recipients (KTRs),
especially when extended-criteria donors (ECDs) are used. HMP can also
improve graft survival. However, there is a paucity of data on the
determinants of HMP use in clinical practice.
Objective:
We aimed to determine the factors associated with the use of HMP in a cohort
of donors and KTRs.
Design:
Multicenter retrospective cohort study.
Setting:
5 transplant centers in Quebec.
Patients:
159 neurologically deceased donors (NDD) and 281 KTR.
Measurements:
Use of HMP.
Methods:
We collected data on consecutive NDD admitted to a dedicated donor unit in a
single university-affiliated center and their KTRs between June 2013 and
December 2018 in 5 adult transplant centers across the province of Quebec,
Canada. All organs were recovered in a single hospital center where a HMP
device was available for every organ recovered and the decision to use HMP
was left at the discretion of the procurement surgeon. Generalized
estimating equations were used to predict the use of HMP.
Results:
The cohort included 159 NDDs and their 281 KTRs. Thirty-three percent of
donors were ECDs, and 59% of KTRs received organs placed on HMP. The median
cold ischemia time (CIT) was 12.5 (IQR 7.9-16.3) hours. In univariate
analysis, none of the donors’ characteristics were associated with the use
of HMP. ECD represented 33% of KTR on HMP vs 35% of those not placed on HMP
(P = .77). In univariate analysis, the use of HMP was
associated with KTR race (non-Caucasian), longer CIT, use of
basiliximab/alemtuzumab, year of transplant, and transplant center. The use
of HMP varied largely across transplant centers, ranging from 15% to 82%. In
multivariate analysis, use of HMP was associated with longer CIT (odds ratio
[OR] 1.15, 95% confidence interval [CI] = 1.07-1.25), transplant center as
well as transplantations performed after 2013.
Limitations:
One dedicated donor unit including NDD only, absence of specific data on
surgeons’ experience and personal or logistic reasons for using or not
HMP.
Conclusions:
We found that use of HMP remains low and varies largely across transplant
centers. The use of HMP was strongly associated with the transplant center
where the surgeons practiced, suggesting that surgeon preference/training
plays an important role in determining the use of HMP. Availability of HMP
at the time of organ procurement might also be limited by logistic issues
such as difficulty in returning the device. Further studies aimed at
determining the reasons underlying the barriers precluding the use of HMP
could help increasing its use and improve transplant outcomes.
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