Hypothermic Machine Perfusion of Extended Donor Criteria Renal Allografts Before Kidney Transplantation: a Systematic Review

Purpose of review Due to the growing need for organs to be transplanted, methods for expanding organ utilization must be explored. While effective in cost and outcomes for optimal donor organs, traditional static cold storage (SCS) is less suitable for use in marginal organ transplants, where hypothermic machine perfusion has several attractive advantages. This systematic review aims to summarize the literature regarding outcomes for transplanting extended criteria donor kidneys preserved by machine perfusion. Recent findings A systematic literature search of PubMed and the ClinicalTrials.gov registry was performed. eGFR, serum creatinine, delayed graft function rate, length of stay and graft, and patient survival rate were demonstrated. Sixteen articles that assessed kidney function and patient outcomes after using hypothermic machine perfusion as part of organ revitalization were included. Regarding DGF, HMP showed a significantly lower DGF rate compared to SCS (P < 0.0001). Two studies found a significantly lower hospital stay in the HMP group. eGFR was comparable between the HMP and SCS groups. One-year allograft survival was meaningfully higher in the HMP group (P = 0.04). One-year patient survival was comparable between the two groups. Our systematic review summarized the literature regarding outcomes for transplant of extended criteria and marginal kidneys preserved by hypothermic machine perfusion and possible comparison with the traditional static cold storage method, with particular emphasis on patients' outcomes. Hypothermic machine perfusion can improve some aspects of the transplant outcomes in extended criteria donor kidneys.