• Victoria Gómez-Dos Santos, Mercedes Ruiz Hernández, and Francisco Javier Burgos-Revilla.
• Urology Department, Ramón y Cajal University Hospital, Surgical Urology and Transplantation Research Group, IRYCIS, Alcalá University, Madrid, Spain.
• Eur Urol Focus. 2018 Mar 1; 4 (2): 163-168.

BackgroundHypothermic machine perfusion (HMP) of deceased donor kidneys is associated with a better outcome than static cold storage, predominantly in marginal donors. Nevertheless, there is little evidence supporting whether graft centre of origin and donor category impact HMP results.ObjectiveTo identify factors impacting HMP in transplantation from marginal donors.Design, Setting, And ParticipantsAnalysis of prospectively collected cohort data of expanded criteria donor (ECD) and donor after circulatory death (DCD) categories II and III was performed. A total of 214 adult recipients of first kidney transplantation with complete data and a minimum of 6-mo follow-up were included.Outcome Measurements And Statistical AnalysisDelayed graft function (DGF) was defined as the lack of decrease in creatinine level in the first 48h. Graft loss was defined as return to dialysis or creatinine clearance <15ml/min/1.73m2. Univariate and multivariate logistic regression analyses for DGF were constructed to identify independent risk factors. Recipient and graft survival (GS) analyses were conducted by Kaplan-Meier, and univariate and multivariate Cox regression analyses.Results And LimitationDGF occurred in 32.8% of imported and 20.5% of local grafts (p=0.059). Only donor category (DCD; odds ratio [OR]: 6.6, p=0.008) and haemodialysis (OR: 3.5, p=0.002) were significantly associated with DGF development. The 1-yr GS rate was 92.5% in the local donor group and 84.3% in the imported donor group (p=0.050). Multivariate analysis by Cox proportional hazards model identified only donor category (hazard ratio [HR] 10.99, p=0.001) and donor age (HR 1.07, p=0.005) as predictive variables for GS. The small sample size of the DCD group diminished the statistical power and did not permit a subgroup analysis to determine the impact of specific DCD category on HMP results.ConclusionsDCD donor category, but not donor centre of origin, impacted DGF development and GS in the HMP of deceased donor kidneys.Patient SummaryCurrently, the number of donors is insufficient to meet the demand for renal grafts. Expanded criteria for donation after brain death and donation after circulatory death (DCD) programmes have been developed as strategies to minimise this problem. Hypothermic machine perfusion has previously demonstrated its usefulness in expanded criteria donation and DCD preservation. DCD type and donor age increase the risk of graft loss.Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.

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