Normothermic and hypothermic machine perfusion preservation versus static cold storage for deceased donor kidney transplantation.
Tingle, S. J., et al.Cochrane Database of Systematic Reviews 2024; 7: CD011671.
Aims
The aim of this study was to compare standard static cold storage (SCS) with machine perfusion technologies, including hypothermic and (sub) normothermic machine perfusion, for deceased donor kidney transplantation.
Interventions
The Cochrane Kidney and Transplant Register of Studies was searched for relevant literature. Studies were selected for inclusion and data were extracted by two independent reviewers. The assessment of methodological quality of the included studies was conducted using the Cochrane risk of bias tool.
Participants
22 studies were included in the review.
Outcomes
The primary outcome was the incidence of delayed graft function. The secondary outcomes included graft survival, duration of delayed graft function (DGF), incidence of acute rejection and primary nonfuction, episodes of biopsy-proven rejection, patient survival, presence of fibrosis on biopsy, hospital stay, early hospital costs, number of graft ultrasound scans and graft biopsies, kidney function, economic implications and quality of life.
Follow-up
N/A
CET Conclusions
This systematic review aimed to compare hypothermic machine perfusion (HMP) and (sub) normothermic machine perfusion (NMP) with each other as well as with standard static cold storage (SCS). Two reviewers independently assessed studies for eligibility and extracted data into standardised extraction forms. A total of 22 randomised controlled trials (RCTs) and quasi-RCTs were included. The findings revealed that, compared to SCS, continuous non-oxygenated HMP reduced the incidence of delayed graft function, had significantly better graft survival while also being cost-effective. An hour of end-ischaemic NMP did not show significant benefits over SCS alone, and also showed inferior graft survival when indirectly compared to continuous HMP. However, it is important to note that only one study was found to assess NMP. Overall, the study methodology was sound. Heterogeneity was significant for some of the outcomes, which the authors attempted to explore using subgroup analysis.
Trial registration
N/A