Rescue by Hypothermic Oxygenated Machine Perfusion for Unexpected Long Prolongation of Cold Preservation Time in Expanded Criteria Donor Kidneys Can Achieve Favorable 2-Year Outcomes.

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2026-05-01 DOI:10.1111/ctr.70557

Silvia Mingozzi, Alberto Mella, Caterina Dolla, Ester Gallo, Ana Maria Manzione, Enrico Sanna, Paolo Randone, Rita Tarragoni, Roberta Giraudi, Gloria Giovinazzo, Claudia Melloni, Aldo Verri, Andrea Bosio, Paolo Gontero, Antonella Barreca, Fabrizio Fop, Luigi Biancone

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Abstract

Background: Hypothermic oxygenated machine perfusion (HOPE) is occasionally used to overcome logistical issues and allow longer cold preservation time (CPT); however, reports regarding these situations in older brain-dead donors are lacking.

Methods: Retrospective analysis of kidney transplants (KTs) performed between January 1, 2015, to December 31, 2023, from extended criteria donors (ECDs) switched to HOPE after a median time of 17.1 h in static cold storage (SCS) for unexpected logistic reasons and with a median total CPT of 28.6 h (25.3-32.0) (n = 44, HOPE ECDs), compared with a control group of KTs (n = 44, L-ECDs) maintained in SCS alone with a low CPT (median, 10.4 h; range, 7.1-11.1) and matched for age, sex, donor age, donor eGFR, pre-emptive transplant, and cPRA.

Results: No primary nonfunction was observed, and both death-censored graft survival (DCGS) and renal function progressively improved, remaining satisfactory and superimposable between groups up to two years post-transplant (97.7% of DCGS with mean eGFR 46.5 mL/min/1.73 m² [36-55.65] in HOPE-ECDs) versus 97.7% with 42.0 (30.2-48.2) in L-ECDs with similar KDPI (67% [49.75-86.5] vs. 72.5% [60.5-87.75], p = 0.475). These results were achieved in patients with HOPE-ECDs, who experienced higher rates of DGF (31.8% vs. 11.4%, p = 0.036). No differences were noted in infection or rejection rates.

Conclusion: Rescue by HOPE after SCS in ECDs with a very long CPT can achieve midterm outcomes similar to those with a low CPT in SCS alone, paving the way for its safe implementation in clinical practice.

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在扩大标准的供肾中，低温充氧机灌注对意外延长冷保存时间的抢救可以获得良好的2年预后。

背景：低温氧机灌注（HOPE）偶尔被用于克服后勤问题和允许更长的冷保存时间（CPT）；然而，缺乏关于老年脑死亡供体的这些情况的报告。方法：回顾性分析2015年1月1日至2023年12月31日期间进行的肾移植（KTs），从延长标准供体（ECDs）在静态冷库（SCS）中位时间为17.1小时后切换到HOPE，中位总CPT为28.6小时（25.3-32.0）（n = 44, HOPE ECDs），而对照组的KTs （n = 44, L-ECDs）仅在SCS中维持低CPT(中位，10.4小时；范围7.1-11.1)，并匹配年龄、性别、供者年龄、供者eGFR、抢先移植和cPRA。结果：未观察到原发性无功能，移植后两年内两组之间的死亡-切除移植存活（DCGS）和肾功能均逐渐改善，保持令人满意和重叠（97.7%的希望- ecds，平均eGFR为46.5 mL/min/1.73 m2[36-55.65]），而97.7%的L-ECDs，平均eGFR为42.0 (30.2-48.2)，KDPI相似（67%[49.75-86.5]对72.5% [60.5-87.75],p = 0.475）。这些结果是在HOPE-ECDs患者中获得的，他们经历了更高的DGF率（31.8%比11.4%,p = 0.036）。在感染和排异率方面没有发现差异。结论：超长CPT的ECDs在SCS后进行HOPE抢救可以获得与单独SCS低CPT患者相似的中期结果，为其在临床实践中的安全实施铺平了道路。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.