Machine perfusion versus cold storage for preservation of kidneys from expanded criteria donors after brain death


  • Conflicts of Interest
    Drs. Maathuis, Moers, Paul, and Leuvenink and Mrs. van Kasterop-Kutz report receiving one congress travel grant from Organ Recovery Systems; Dr. Pirenne, receiving a research grant from the government of Flanders, Belgium, in cooperation with Organ Recovery Systems to study machine perfusion of liver grafts, for which he receives no salary; Dr. Ploeg, receiving consulting fees from Bristol-Myers Squibb and grant support from Nuts Ohra Trust; Dr. Moers, receiving grant support from the Dutch Kidney Foundation; Dr. Leuvenink, receiving grant support from the Dutch Kidney Foundation and the Eurotrans-Bio pro-donor project; and Drs. Ploeg and Leuvenink, having a patent on a portable preservation apparatus for donor organs. No other potential conflict of interest relevant to this article was reported.

Andreas Paul MD, PhD, Clinic for General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstraße 55, D-45122 Essen, Germany. Tel.: +49 201 723 1100; fax: +49 201 723 5946; e-mail:


The purpose of this study was to analyze the possible effects of machine perfusion (MP) versus cold storage (CS) on delayed graft function (DGF) and early graft survival in expanded criteria donor kidneys (ECD). As part of the previously reported international randomized controlled trial 91 consecutive heart-beating deceased ECDs – defined according to the United Network of Organ Sharing definition – were included in the study. From each donor one kidney was randomized to MP and the contralateral kidney to CS. All recipients were followed for 1 year. The primary endpoint was DGF. Secondary endpoints included primary nonfunction and graft survival. DGF occurred in 27 patients in the CS group (29.7%) and in 20 patients in the MP group (22%). Using the logistic regression model MP significantly reduced the risk of DGF compared with CS (OR 0.460, P = 0.047). The incidence of nonfunction in the CS group (12%) was four times higher than in the MP group (3%) (P = 0.04). One-year graft survival was significantly higher in machine perfused kidneys compared with cold stored kidneys (92.3% vs. 80.2%, P = 0.02). In the present study, MP preservation clearly reduced the risk of DGF and improved 1-year graft survival and function in ECD kidneys.

(Current Controlled Trials number: ISRCTN83876362).