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Kidney Week

Abstract: PO2420

Factors Associated with the Use of Hypothermic Machine Perfusion in Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Goulamhoussen, Nadir, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
  • Slapcoff, Lawrence, McGill University, Montreal, Quebec, Canada
  • Baran, Dana, McGill University, Montreal, Quebec, Canada
  • Houde, Isabelle, CHU Québec, Quebec, Quebec, Canada
  • Boucher, Anne, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Albert, Martin, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
  • Marsolais, Pierre, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
  • Cardinal, Heloise, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
  • Bouchard, Josee, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
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. However, there is a paucity of data on the determinants of HMP use in real-life setting.

Methods

We aimed to determine the factors associated with the use of HMP in a cohort of donors and KTRs. We collected data on consecutive brain-dead donors admitted to an organ procurement organization and their KTRs between June 2013 and December 2018 in 5 adult transplant centers in Canada. There is no standardized protocol for the use of HMP in the province of Quebec. The use of HMP is left at the discretion of the surgeon recovering organs. However, a HMP device was available for every organ recovered at the organ procurement organization. Generalized estimating equations were used to predict the use of HMP.

Results

The cohort included 159 deceased donors 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 12.4 (IQR 7.9-16.2) hours. There were no differences in use of HMP over time. In univariate analysis, none of the donors’ characteristics were associated with the use of HMP. The use of HMP was similar in ECD and standard criteria donors (33% vs 34%, p=0.82). For KTRs, in univariate analysis, race (non-Caucasian), cold ischemia time, use of basiliximab/alemtuzumab, and KTR center were associated with the use of HMP. In multivariate analysis, CIT (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.03-1.16) and KTR center were significantly associated with use of HMP.

Conclusion

We found that 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. The presence of ECD did not influence the use of HMP. The reasons underlying the differences in practice between centers should be explored in further studies.

Funding

  • Government Support - Non-U.S.