Systematic Review of Preservation Solutions for Static Cold Storage of Kidneys

We have recently completed a systematic review of preservation solutions for the static cold storage of kidney allografts (this was presented at the recent ESOT meeting and has been accepted for publication subject to satisfactory revision). We used MEDLINE, EMBASE, the Cochrane Library and the Transplant Library to perform the literature search. Searches combined MeSH and EMTREE keywords with free-text aliases for the preservation solutions. No date or language limits were applied. Inclusion criteria specified any comparative, prospective study of preservation solutions for cadaveric renal allografts.

15 trials with a total of 3,584 kidneys were included (10 RCTs and 5 Non-RCTS). We found that the risk of DGF is increased with EC stored kidneys when compared to both UW and HTK in the largest, best quality RCTs. On the basis of the 3 RCTs that compared UW with Celsior and 2 that compared UW with HTK, we concluded that these 3 solutions are associated with a comparable risk of DGF. We were able to combine the results for comparisons of UW and Celsior in a fixed effects meta-analysis to demonstrate that the risk of DGF was equal (RR=0.97, CI= 0.76-1.23, p=0.79).

There does not appear to be support for the use of one of these 3 solutions over another on the basis of cost as prices per litre are similar, as are the recommended flush volumes. Most surprisingly, there has been no RCT comparing hypertonic citrate (HOC) for renal preservation to any of the solutions in use before its development, or to newer solutions such as UW and HTK. Overall, the level of available evidence was low and a limited amount of prospective evidence was available. Furthermore the methodological quality of most of the trials that met the inclusion criteria was poor. We are now examining the evidence for preservation methods in non-renal abdominal organs.