Education Corner – Kidney Pumping

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Kidney Pumping – What does the data show?
What is kidney pumping?

When kidneys are recovered from a deceased donor there is a kidneyallocationsystemvariable delay prior to transplantation. In order to minimize ischemic damage to the tissue cells, historically, kidneys would be preserved with static cold storage (CS), e.g. in a cool box. An alternative to CS is to utilize machine perfusion (MP), commonly known as kidney pumping.

How does kidney pumping work?

MP entails placing kidneys on a pump to provide circulation of kidneytissuepreservation solution, usually at hypothermic temperatures. The perfusion of the kidney promotes equilibration of the interstitium, removal of toxic metabolites, and delivers oxygen and nutrients, allowing for better graft preservation, pre-transplant assessment, and optimization.

Are all kidneys pumped?

Currently, in the U.S., mainly kidneys recovered from Extended Criteria Donors (ECD) and Donation after Circulatory Death (DCD) donors are being pumped.

What does the data show and how might this impact practice?

A randomized controlled trial in Europe demonstrated significant reduction in delayed graft function (DGF) with the use of MP (Moers et al, 2009). In this trial, Standard Criteria Donors (SCD), ECD, and DCD donors were included (n=336) and it was identified that DGF decreased from 26.5% to 20.8%.

The U.S. retrospective review study conducted by Dr. Franklin and Dr. Cannon hypothesized that machine perfusion in the U.S. will also decrease episodes of DGF (2013). This study reviewed all adult isolated kidney transplants from 1/1/2005 to 3/31/2011 (n=52,052), including all SCD, ECD, and DCD donors, comparing MP (38%) to CS (62%) kidney outcomes. Findings demonstrated, after propensity matching, that DGF occurred in 21% of MP kidneys vs 29% of CS kidneys (p < 0.001), which translates into every 12.5 MP kidneys one episode of DGF will be prevented.

Even for SCD donors, DGF rates were 16.8% for MP kidneys vs 25.3% for CS kidneys. This demonstrated an 8.5% absolute reduction in DGF (2015).

While further work is still needed to determine the idealors_8_626px population and cost neutrality for MP benefit, the clinical conclusion recommends the expansion of MP beyond its current level of utilization would likely be beneficial in reducing DGF.

Taken from a webinar presentation by Glen A. Franklin, MD, (Professor & Vice Chairman for Education, Hiram C Polk Jr MD, Department of Surgery, University of Louisville, Louisville, KY, Medical Director, KY Organ Donor Affiliates).  Special thanks to Dr. Franklin for his contributions to this inservice.

The webinar presentation “Innovation webinar: Kidney Pumping – What does the data show and what does the future hold?” is available through the Alliance Academy: https://organdonationalliance.org/alliance-academy/

References:
Moers C, Smits JM, Maathuis MH, et al. Machine perfusion or cold storage in deceased-donor kidney transplantation. N Engl J Med, 2009; 360(1):7-19. doi:10.1056/NEJMoa0802289.
Cannon RM, Brock GN, Garrison RN, et al. To pump or not to pump: a comparison of machine perfusion vs cold storage for deceased donor kidney transplantation. J Am Coll Surg, 2013; 216(4):625-634. doi: 10.1016/j.jamcollsurg.2012.12.025.
Cannon RM, Brock GN, Garrison RN, et al. Machine perfusion: not just for marginal kidney donors. Am Surg, 2015; 81(6):550-556.
Nath J, Effects of machine perfusion on cadaveric kidneys for transplantation. http://www.hra.nhs.uk/news/research-summaries/effects-of-machine-perfusion-on-cadaveric-kidneys-for-transplantation/

Editor: Hedi Aguiar RN, MSN, Director of Programs and Communications, The Alliance, haguiar@odt-alliance.org.
This Education Corner is available for download. The Alliance grants permission for the distribution and reproduction of this educational communication.

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