Cargando…

Trends and Outcomes of Hypothermic Machine Perfusion Preservation of Kidney Allografts in Simultaneous Liver and Kidney Transplantation in the United States

Optimal kidney graft outcomes after simultaneous liver-kidney (SLK) transplant may be threatened by the increased cold ischemia time and hemodynamic perturbations of dual organ transplantation. Hypothermic machine perfusion (MP) of kidney allografts may mitigate these effects. We analyzed U.S. trend...

Descripción completa

Detalles Bibliográficos
Autores principales: Chang, Alex, Schaubel, Douglas E., Chen, Melissa, Abt, Peter L., Bittermann, Therese
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8958417/
https://www.ncbi.nlm.nih.gov/pubmed/35356400
http://dx.doi.org/10.3389/ti.2022.10345
_version_ 1784676938384670720
author Chang, Alex
Schaubel, Douglas E.
Chen, Melissa
Abt, Peter L.
Bittermann, Therese
author_facet Chang, Alex
Schaubel, Douglas E.
Chen, Melissa
Abt, Peter L.
Bittermann, Therese
author_sort Chang, Alex
collection PubMed
description Optimal kidney graft outcomes after simultaneous liver-kidney (SLK) transplant may be threatened by the increased cold ischemia time and hemodynamic perturbations of dual organ transplantation. Hypothermic machine perfusion (MP) of kidney allografts may mitigate these effects. We analyzed U.S. trends and renal outcomes of hypothermic non-oxygenated MP vs. static cold storage (CS) of kidney grafts from 6,689 SLK transplants performed between 2005 and 2020 using the United Network for Organ Sharing database. Outcomes included delayed graft function (DGF), primary non-function (PNF), and kidney graft survival (GS). Overall, 17.2% of kidney allografts were placed on MP. Kidney cold ischemia time was longer in the MP group (median 12.8 vs. 10.0 h; p < 0.001). Nationally, MP utilization in SLK increased from <3% in 2005 to >25% by 2019. Center preference was the primary determinant of whether a graft underwent MP vs. CS (intraclass correlation coefficient 65.0%). MP reduced DGF (adjusted OR 0.74; p = 0.008), but not PNF (p = 0.637). Improved GS with MP was only observed with Kidney Donor Profile Index <20% (HR 0.71; p = 0.030). Kidney MP has increased significantly in SLK in the U.S. in a heterogeneous manner and with variable short-term benefits. Additional studies are needed to determine the ideal utilization for MP in SLK.
format Online
Article
Text
id pubmed-8958417
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-89584172022-03-29 Trends and Outcomes of Hypothermic Machine Perfusion Preservation of Kidney Allografts in Simultaneous Liver and Kidney Transplantation in the United States Chang, Alex Schaubel, Douglas E. Chen, Melissa Abt, Peter L. Bittermann, Therese Transpl Int Health Archive Optimal kidney graft outcomes after simultaneous liver-kidney (SLK) transplant may be threatened by the increased cold ischemia time and hemodynamic perturbations of dual organ transplantation. Hypothermic machine perfusion (MP) of kidney allografts may mitigate these effects. We analyzed U.S. trends and renal outcomes of hypothermic non-oxygenated MP vs. static cold storage (CS) of kidney grafts from 6,689 SLK transplants performed between 2005 and 2020 using the United Network for Organ Sharing database. Outcomes included delayed graft function (DGF), primary non-function (PNF), and kidney graft survival (GS). Overall, 17.2% of kidney allografts were placed on MP. Kidney cold ischemia time was longer in the MP group (median 12.8 vs. 10.0 h; p < 0.001). Nationally, MP utilization in SLK increased from <3% in 2005 to >25% by 2019. Center preference was the primary determinant of whether a graft underwent MP vs. CS (intraclass correlation coefficient 65.0%). MP reduced DGF (adjusted OR 0.74; p = 0.008), but not PNF (p = 0.637). Improved GS with MP was only observed with Kidney Donor Profile Index <20% (HR 0.71; p = 0.030). Kidney MP has increased significantly in SLK in the U.S. in a heterogeneous manner and with variable short-term benefits. Additional studies are needed to determine the ideal utilization for MP in SLK. Frontiers Media S.A. 2022-03-14 /pmc/articles/PMC8958417/ /pubmed/35356400 http://dx.doi.org/10.3389/ti.2022.10345 Text en Copyright © 2022 Chang, Schaubel, Chen, Abt and Bittermann. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Health Archive
Chang, Alex
Schaubel, Douglas E.
Chen, Melissa
Abt, Peter L.
Bittermann, Therese
Trends and Outcomes of Hypothermic Machine Perfusion Preservation of Kidney Allografts in Simultaneous Liver and Kidney Transplantation in the United States
title Trends and Outcomes of Hypothermic Machine Perfusion Preservation of Kidney Allografts in Simultaneous Liver and Kidney Transplantation in the United States
title_full Trends and Outcomes of Hypothermic Machine Perfusion Preservation of Kidney Allografts in Simultaneous Liver and Kidney Transplantation in the United States
title_fullStr Trends and Outcomes of Hypothermic Machine Perfusion Preservation of Kidney Allografts in Simultaneous Liver and Kidney Transplantation in the United States
title_full_unstemmed Trends and Outcomes of Hypothermic Machine Perfusion Preservation of Kidney Allografts in Simultaneous Liver and Kidney Transplantation in the United States
title_short Trends and Outcomes of Hypothermic Machine Perfusion Preservation of Kidney Allografts in Simultaneous Liver and Kidney Transplantation in the United States
title_sort trends and outcomes of hypothermic machine perfusion preservation of kidney allografts in simultaneous liver and kidney transplantation in the united states
topic Health Archive
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8958417/
https://www.ncbi.nlm.nih.gov/pubmed/35356400
http://dx.doi.org/10.3389/ti.2022.10345
work_keys_str_mv AT changalex trendsandoutcomesofhypothermicmachineperfusionpreservationofkidneyallograftsinsimultaneousliverandkidneytransplantationintheunitedstates
AT schaubeldouglase trendsandoutcomesofhypothermicmachineperfusionpreservationofkidneyallograftsinsimultaneousliverandkidneytransplantationintheunitedstates
AT chenmelissa trendsandoutcomesofhypothermicmachineperfusionpreservationofkidneyallograftsinsimultaneousliverandkidneytransplantationintheunitedstates
AT abtpeterl trendsandoutcomesofhypothermicmachineperfusionpreservationofkidneyallograftsinsimultaneousliverandkidneytransplantationintheunitedstates
AT bittermanntherese trendsandoutcomesofhypothermicmachineperfusionpreservationofkidneyallograftsinsimultaneousliverandkidneytransplantationintheunitedstates