THE ROLE OF HYPOTHERMIC MACHINE PERFUSION IN SELECTING RENAL GRAFTS WITH ADVANCED HISTOLOGICAL SCORE

Background: No definitive data exist on the protective effect of hypothermic perfusion machine (HPM) in the setting of deceased brain death (DBD) kidney transplantation (KT). We aimed at comparing the post-KT clinical course of two preliminarily “balanced” groups of patients undergoing KT with DBD grafts perfused with HPM or preserved with static cold storage (SCS). Methods: During the period Jan 2014-Sep 2021, 313 patients were transplanted at Sapienza University of Rome. The population was stratified in two groups according to the type of graft preservation: SCS Group (n=218, 69.6%), and HPM Group (n=95, 30.4%). With the intent to compensate for the non-randomized design of this retrospective study, the two groups were “balanced” using a stabilized inverse probability therapy weighting (IPTW). Results: After IPTW balancing, no differences were observed between the two groups in terms of post-KT delayed graft function (DGF) rates. In detail, need for dialysis within the first week after KT was observed in 17.9 vs. 15.6% of cases in SCS and HPM cases, respectively (P=0.75). HPM cases has a shorter period of ICU stay (P<0.0001) and a shorter, although not statistically relevant, overall hospital stay (P=0.07). When the sub-class of cases requiring a biopsy before KT was explored, more relevant differences were observed. Need for dialysis was more common in SCS cases (23.9 vs. 7.7%; P=0.03). ICU and overall hospital stay were always shorter in the HPM Group (P=0.002 and 0.007, respectively). Conclusion: The use of perfusion machine positively impacts on the early recovery of DBD renal grafts. This positive phenomenon is more marked in cases requiring biopsy at the time of organ retrieval (i.e., aged donors or presence of relevant donor comorbidities). The routine use of a tailored HPM approach should hesitate in a reduction of post-transplant dialysis rates, and shorter hospital stay.