parameters trial [14]. It was an international randomized,

such as perfusate biomarkers or perfusion dynamics (flow rates, vascular
resistance) etc 8.  



is a substantive body of literature supporting the superiority of machine
perfusion (hypothermic) to static cold storage. 
 A highly valued study was one
known as Eurotrasplant machine perfusion trial 14. It was an international
randomized, controlled trial, where they randomly assigned one kidney from 336
consecutive deceased donors to machine perfusion and the other one to cold
storage. The follow up of the 672 recipients was 1 year. The main endpoint was
delayed graft function as assessed by need of dialysis in the first week after
transplantation.  They showed that MP led
to significant reduction of the risk of delayed graft function as it developed
only in 70 patients in that group versus 89 in the cold-storage group (adjusted
odds ratio, 0.57; P=0.01). Moreover, MP statistically significantly increased
the reduction in serum creatinine level, shortened the duration of DGF if
present and was found to guarantee lower serum creatinine levels during the
first two weeks post transplantation 14.


Analysing this study further one can comment on the
large number of exclusions however the sample is still large (654 pairs
initially screened and 336 of them included). 
Authors supported that from its design as paired design there was no alternative.  Also, another potential bias was that in a
small number of patients, the initial randomization was switched due to variances
in the vascular anatomy. Overall it is a large study which favours HMP.


highly valued study is an extension of Eurotransplant machine perfusion trial.
This targeted specifically at DCD kidneys. It was a multicentre, randomized,
controlled trial. The sample included eighty-two kidney pairs from consecutive,
controlled DCD adult donors. From each pair one kidney was randomly assigned to
machine perfusion and the contralateral kidney to static cold storage randomly.
The primary outcome was the effect of the mode of preservation in delayed graft
function (DGF) which was evaluated by the requirement of dialysis one-week post
transplantation. The follow up was for 1-year post transplantation.  This study showed that machine perfusion led
to reduction of DGF from 69.5% to 53.7% (adjusted odds ratio: 0.43; 95%
confidence interval 0.20–0.89; P = 0.025). Also, it was four days shorter in
those who received hypothermic machine-perfused kidneys (P = 0.082) and these
kidneys had a higher creatinine clearance for the first month post
transplantation. However, the survival of the graft and the patient at the endpoint
of this study (one year) was similar in both groups (machine perfusion Vs
static cold storage) (93.9% vs 95.1%). 15

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study overall showed that hypothermic machine perfusion was resulting in a
reduction of the risk of DGF and improved early graft function up to 1 month
after transplantation.  Therefore, the
authors advised that routine use of HMP is preferable in preservation of DCD
kidneys 15. However, there are few points that one could raise.  One is this study’s sample (82 pairs) that is
not too large but understandably enough it is still hard to expand it in
transplantation studies. Also, in order to reach these 82 pairs, the research
team screened 204 pairs therefore there was a significant proportion of
exclusions (reasons for exclusions; could not be reached in time, refusal by
donor centre, cancelled donor procedures, not both kidneys transplantable,
solitary kidneys, kidneys not able to be machine perfused, kidneys not
transplantable post preservation, no suitable recipient, technical failures,
both kidneys transplanted to same patient.) The authors supported that this was
a result of the design of their trial (strictly paired) and the ethical and
practical necessity to randomize kidney pairs ASAP after a potential donor was
found. Secondly, the follow up period of a year one can support that could be
longer. Another limitation is the use of different preservation solutions
amongst the two groups (KPS-1 in MP and UW or HTK in SCS group). Lastly the clinical
significance of the results is questionable. This is because even though DGF has
been recognised as a risk factor for graft failure (post kidney transplantation)
and this study showed that machine perfusion significantly reduced the risk for
DGF at the same time it did not show improvement in 1-year graft survival of
machine-perfused as compared to static cold-stored kidneys. Also, the graft’s
creatinine clearance was higher only for the first month in the MP group. 15


According to the
British Transplantation Society and its guidelines 16 with regards to MP
versus SCS there is uncertainty in the value of HMP of kidneys prior to
transplantation and absence of evidence supporting it in DCD. However,
according to a recent study 17 the MP improved graft survival was only shown
to the DBD organs and to ECD in particular. This was an extension of the
Eurotransplant trial where the follow up was extended to 3 years post