Ex vivo kidney machine perfusion: meta-analysis of randomized clinical trials

Kumar M, Patil NS, Mohapatra N, Sindwani G, Dhingra U, Yadav A et al.
Ann Surg 2024; 279: 932-944.

A temporary shunt reduced intra-operative blood loss (P=0.004) and need for transfusion in this study of 60 procedures. The shunted patients were also more haemodynamically stable in the anhepatic phase, requiring less vasopressor support, with better postoperative renal function. There were no other differences in postoperative outcomes.

Comment: The observed advantages should improve outcomes, but perhaps the study was too small to be definitive.

Markmann JF, Aboulijoud MS, Ghobrial RM, Bhati CS, Pelletier SJ, Lu AD et al.

JAMA Surg 2022; 157: 189-198.

Of 293 patients included, machine perfusion reduced the rate of early graft dysfunction (18 versus 31 per cent, P=0.01), and improved use of the liver from donors after cardiac death (51 versus 26 per cent, P=0.007).

Comment: Increasing evidence of the value of this technology.

Malinoski D, Saunders S, Swain S, Groat T, Wood PR, Reese J et al.

N Engl J Med 2023; 388: 418-426.

Some 1349 kidneys were transplanted from 725 deceased donors. Hypothermia was inferior to machine perfusion (or both) in terms of delayed graft function (30 versus 19 per cent), but after one year, graft survival rates were similar.

Comment: So the question is whether reduced delayed graft function is sufficient justification for machine perfusion.