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Abstract：
Hypothermic machine perfusion (HMP) has been shown to reduce delayed graft function (DGF)-rates in kidneys from expanded criteria donors (ECD) and may increase graft survival compared with static cold storage (SCS). This single-center, retrospective observational study aimed to evaluate this effect. The primary endpoint was the DGF-rate, defined as the use of dialysis in the first postoperative week, excluding the first 24 h. The main secondary endpoint was graft survival at 5 years. Recipients of ECD-kidneys between 2013 and 2021 with ≤2 grafts were included (n = 438). The SCS-kidneys were marginal-matched by propensity score to the HMP-group for donor age, cold ischemia time, and graft number. Multivariable adjusted analysis for confounders in the unmatched cohort and caliper-based ID-matching constituted sensitivity analyses. HMP showed a trend to lower DGF-rate in the marginal-matched comparison (9.2% vs. 16.1%, p = 0.063). This was strengthened by a significant benefit observed for HMP in both the sensitivity analyses: an adjusted OR of 0.45 (95% CI: 0.24; 0.84; p = 0.012) in the multivariable analysis and DGF-rate of 8.7% vs. 17.4% (p = 0.024) after ID-matching. The 5-year graft survival rate was >90% in both groups, with no benefit using HMP (HR = 0.79; 95% CI:0.39-1.16; p = 0.52). Our results suggest that HMP may be effective in decreasing DGF-rates, however, without any significant benefit in graft survival.
摘要：
与静态冷藏（SCS）相比，低温机器灌注（HMP）已显示可降低扩大标准供体（ECD）肾脏中延迟的移植物功能（DGF）速率，并可能增加移植物存活率。这个单一中心，回顾性观察性研究旨在评估这种效果。主要终点是DGF率，定义为在术后第一周使用透析，不包括前24小时。主要次要终点是5年的移植物存活率。包括2013年至2021年之间的ECD肾脏受体，其中≤2个移植物（n=438）。SCS-肾脏通过倾向评分与供体年龄的HMP组边缘匹配，冷缺血时间，和移植数量。不匹配队列中混杂因素的多变量调整分析和基于卡尺的ID匹配构成敏感性分析。HMP在边际匹配比较中显示出降低DGF率的趋势(9.2%与16.1%,p=0.063)。在两个敏感性分析中观察到HMP的显着益处加强了这一点：多变量分析中的校正OR为0.45（95％CI：0.24;0.84;p=0.012），DGF率为8.7％vs.ID匹配后为17.4%(p=0.024)。两组的5年移植物存活率均>90%,使用HMP没有益处(HR=0.79；95%CI：0.39-1.16；p=0.52)。我们的结果表明，HMP可能有效降低DGF的发生率，然而,对移植物存活没有任何显著的益处。
