Role of machine perfusion preservation in kidney transplantation from non‐heartbeating donors

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Abstract
The shortage of kidneys for transplantation is a universal problem. If the viability of the kidney can be assured, organ procurement from non‐heartbeating donors will be greatly enhanced. This study evaluates the usefulness of machine perfusion preservation parameters as an index of kidney graft viability. We report our experience with 77 non‐heartbeating donor kidneys preserved with machine perfusion technique. Sixty‐eight grafts demonstrated excellent perfusion (mean flow 0.79 ml/min/g) with low vascular resistance (55.4 mmHg/ ml/min/g). Early graft function occurred in all of these kidneys. Nine kidneys demonstrated poor perfusion (mean flow 0.35 ml/min/g) and elevated pressures with high vascular resistance (132.5 mmHg/ml/min/g). Four kidneys with poor perfusion and elevated pressures was discarded after perfusion. The four mates of these discarded at our center were primarily non‐functional when transplanted at another transplant center. All five of the poorly perfused kidneys experienced primary nonfunction. We conclude that the use of quantitative values of perfusion flow (> 0.4 ml/min/g) and no increased pressure pattern allow safe utilization of grafts from non‐heartbeating donors and can predict early postoperative function.