The Benefit of Sequential Normothermic Regional Perfusion and Hypothermic Machine Perfusion in Kidney Transplantation From Donation After Circulatory Death Donors

IF 1.8 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2026-08-14 DOI:10.1111/ctr.70641

Toshihiro Nakayama, Sue J. Fu, Antony M. Attia, Daniel J. Ahn, Thomas A. Pham, Marc L. Melcher, Kliment K. Bozhilov, Kazunari Sasaki

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引用次数: 0

Abstract

Background

Normothermic regional perfusion (NRP) is associated with improved posttransplant outcomes in donation after circulatory death (DCD) kidney transplantation. It remains unknown whether hypothermic machine perfusion (HMP) offers additional benefits over static cold storage (SCS) during transport.

Methods

All adult kidney-only transplantations from DCD donors procured by NRP in the OPTN data (10/1/2020-6/30/2025) were identified. Primary exposure was preservation method during transport: NRP combined with HMP (NRP+HMP) or SCS (NRP+SCS). One-to-two propensity score matching (PSM) was performed on fifteen donor and recipient factors. Primary outcomes included delayed graft function (DGF), posttransplant length of stay (LOS), and estimated glomerular filtration rate (eGFR) at 6 months posttransplant. Secondary outcomes were one-year graft and patient survival.

Results

Among 4792 NRP cases, HMP was utilized in 85.1%, with its use increasing over time. After 1:2 PSM (685 NRP+SCS matched to 1262 NRP+HMP), NRP+HMP was associated with significantly lower DGF (23.3% vs. 30.5%, p < 0.01). Median LOS (4.0 days in both groups, p = 0.07), 6-month eGFR (58.5 vs. 60.1 mL/min/1.73m², p = 0.46), one-year graft survival, and one-year patient survival were not significantly different. The association between HMP and lower DGF was observed across KDPI strata, heart recovery status, and cold ischemia time categories, with no significant interactions detected.

Conclusion

The adoption of HMP after NRP has increased substantially in the United States and was associated with reduced DGF, but no difference was observed for LOS, 6-month eGFR, graft survival, and patient survival. These findings support the routine use of HMP after NRP.

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循环性死亡供者捐献肾移植后连续常温局部灌注和低温机器灌注的益处

背景：常温区域灌注（NRP）与循环死亡（DCD）肾移植后捐献的移植后预后改善有关。目前尚不清楚在运输过程中，低温机灌注（HMP）是否比静态冷库（SCS）有更多的好处。方法对OPTN数据（2020年10月1日- 2025年6月30日）中所有由NRP获得的DCD供者的成人单肾移植进行鉴定。主要暴露为运输过程中的保存方法：NRP联合HMP （NRP+HMP）或SCS （NRP+SCS）。对15个供体和受体因素进行了一对二倾向评分匹配（PSM）。主要结局包括移植后延迟功能（DGF）、移植后停留时间（LOS）和移植后6个月肾小球滤过率（eGFR）。次要结果是一年的移植和患者生存。结果在4792例NRP病例中，HMP的使用率为85.1%，随时间的推移，HMP的使用率呈上升趋势。1:2 PSM （685 NRP+SCS与1262 NRP+HMP配对）后，NRP+HMP与DGF显著降低相关（23.3%比30.5%,p < 0.01）。中位LOS（两组均为4.0天，p = 0.07）、6个月eGFR （58.5 vs 60.1 mL/min/1.73m2, p = 0.46）、1年移植物生存期和1年患者生存期无显著差异。HMP与低DGF在KDPI分层、心脏恢复状态和冷缺血时间类别中均存在关联，但未发现显著的相互作用。结论：在美国，NRP术后采用HMP的人数大幅增加，并与DGF降低有关，但在LOS、6个月eGFR、移植物生存和患者生存方面没有观察到差异。这些发现支持NRP术后常规使用HMP。

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.