NDLI: Machine perfusion or cold storage in deceased-donor kidney transplantation. (Journal: New England Journal of Medicine Volume: 360 Issue: 1)

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Napieralski, Bogdan P. Treckmann, Jürgen Maathuis, Mark-hugo J. Van Kasterop-kutz, Margitta Van Heurn, Ernest Paul, Andreas Smits, Jacqueline M. Moers, Cyril Van Gelder, Frank Van Der Heide, Jaap J. Homan Pirenne, Jacques Leuvenink, Henri G. D. Kirste, Günter R. Rahmel, Axel Squifflet, Jean-paul Ploeg, Rutger J.
Description	Author Affiliation: Moers C ( Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. c.moers@chir.umcg.nl)
Abstract	BACKGROUND: Static cold storage is generally used to preserve kidney allografts from deceased donors. Hypothermic machine perfusion may improve outcomes after transplantation, but few sufficiently powered prospective studies have addressed this possibility. METHODS: In this international randomized, controlled trial, we randomly assigned one kidney from 336 consecutive deceased donors to machine perfusion and the other to cold storage. All 672 recipients were followed for 1 year. The primary end point was delayed graft function (requiring dialysis in the first week after transplantation). Secondary end points were the duration of delayed graft function, delayed graft function defined by the rate of the decrease in the serum creatinine level, primary nonfunction, the serum creatinine level and clearance, acute rejection, toxicity of the calcineurin inhibitor, the length of hospital stay, and allograft and patient survival. RESULTS: Machine perfusion significantly reduced the risk of delayed graft function. Delayed graft function developed in 70 patients in the machine-perfusion group versus 89 in the cold-storage group (adjusted odds ratio, 0.57; P=0.01). Machine perfusion also significantly improved the rate of the decrease in the serum creatinine level and reduced the duration of delayed graft function. Machine perfusion was associated with lower serum creatinine levels during the first 2 weeks after transplantation and a reduced risk of graft failure (hazard ratio, 0.52; P=0.03). One-year allograft survival was superior in the machine-perfusion group (94% vs. 90%, P=0.04). No significant differences were observed for the other secondary end points. No serious adverse events were directly attributable to machine perfusion. CONCLUSIONS: Hypothermic machine perfusion was associated with a reduced risk of delayed graft function and improved graft survival in the first year after transplantation. (Current Controlled Trials number, ISRCTN83876362.)
ISSN	00284793
Issue Number	1
Volume Number	360
e-ISSN	15334406
Journal	New England Journal of Medicine
Language	English
Publisher	Massachusetts Medical Society (United States)
Publisher Date	2009-01-01
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Kidney Transplantation Organ Preservation Methods Perfusion Adolescent Adult Aged Aged, 80 And Over Cadaver Cold Temperature Creatinine Blood Delayed Graft Function Prevention & Control Graft Rejection Humans Length Of Stay Middle Aged Multivariate Analysis Proportional Hazards Models Survival Analysis Young Adult Comparative Study Journal Article Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't Medicine
Content Type	Text
Resource Type	Article
Subject	Medicine

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