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HMP and cold-preservation time in deceased donor kidney transplantation: IDEAL Stage 4 US cohort study
Results from an idea, development, exploration, assessment, and long-term follow-up (IDEAL) Stage 4 US population cohort study, evaluating whether hypothermic machine perfusion (HMP) mitigates the negative impact of total cold-preservation time (CPT) on short- and long-term clinical outcomes in adult deceased donor kidney transplant recipients (N = 137,835), were published in the American Journal of Transplantation by Amarnath et al. The study used data from the Organ Procurement and Transplantation Network (OPTN) registry. Kidneys were preserved with static cold storage (SCS; n = 71,294), continuous HMP (cHMP; n = 37,245), end-ischemic HMP (eiHMP; n = 11,136), or transport-only HMP (toHMP; n = 18,160). The primary outcome was delayed graft function (DGF), defined as dialysis during the first week post-transplant.
Key data: All HMP modalities were associated with reduced DGF vs SCS: cHMP (adjusted odds ratio [aOR], 0.484; 95% confidence interval [CI], 0.467–0.501); eiHMP (aOR, 0.459; 95% CI, 0.435–0.485); and toHMP (aOR, 0.535; 95% CI, 0.512–0.558) (all p < 0.001). The association strengthened with longer CPT and was greater in donation after circulatory death (DCD) vs donation after brain death (DBD) grafts (interaction p < 0.001). cHMP was associated with lower DGF from 3 hours of CPT (aOR, 0.720; 95% CI, 0.593–0.875), while eiHMP benefit emerged at longer CPT (24 hours: aOR, 0.413; 95% CI, 0.379–0.450; interaction p < 0.001). All HMP modalities were associated with shorter hospital length of stay (all p < 0.001) and improved 5-year graft survival (cHMP, p = 0.045; eiHMP, p < 0.001; toHMP, p = 0.033); cHMP and eiHMP were associated with improved 5-year patient survival (p = 0.018 and p = 0.016, respectively).
Key learning: These real-world findings support consideration of HMP when prolonged cold preservation is anticipated, particularly for DCD grafts, while recognizing the limitations of retrospective registry data and unrecorded HMP duration.
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