Technology wins again???

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The interest in machine perfusion for preservation of kidney transplants has been revived. Were we serious when we decided to put the organ in ice??? A recent NEJM prospective, controlled trial randomizing 336 consecutive deceased donors to either machine prefusion or static cold storage preservation showed the advantage of technology!!!

The incidence of delayed graft function (DGF) was less in the machine perfusion group compared to cold storage (20.8% vs 26.5% respectively, P = 0.01) but if DGF developed, it was 3 days shorter with machine perfusion (10 days vs 13 days, P = 0.04). The most interesting result of this study was that the 1-year kidney graft survival rate was significantly greater in the machine perfusion group (94% vs 90%, P = 0.04). The superiority of the machine perfusion technology was shown regardless of deceased donor category. No differences were noted in patient survival, length of hospital stay, acute rejection, or calcineurin inhibitor toxicity between the 2 groups. Seriously, Ice????


  1. Noting this is a great paper, an interesting fact is that one of the endpoints, delayed graft function, depends on some degree of clinician subjectivity, and given that it was not possible to entirely blind the clinicians about the treatment arms, one has to raise the question of bias (ie: the clinician might have been tempted to "wait things out" a little longer on one treatment groups Vs another). An interesting outcome would be median graft survival, as in theory, one would expect it to be decreased with DGF. Alas, this may be a paper 10 -15 years from now?

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