Functional Results of Renal Preservation in Hypothermic Pulsatile Machine Perfusion Versus Cold Preservation: Systematic Review and Meta-Analysis of Clinical Trials.

Background: Hypothermic pulsatile machine perfusion (HPMP) decreases the rate of delayed graft function (DGF) in kidney grafts, compared with cold storage. However, it is not clear its use in the different subgroups of grafts. The objective was to review systematically all studies with better methodologic quality that compare HPMP versus cold storage.

Methods: A systematic review was performed. The sources were Pubmed, Pubmed Central, Cochrane Library, Clinical Key, and Ovid. All randomized controlled trials that compared HPMP versus cold storage in renal grafts from human donors were considered. Outcomes analyzed were: percentage of DGF, primary nonfunction (PNF), and graft function in each group and for the different types of grafts, brain-death donors (DBDs), and different subgroups of donors after circulatory death (DCDs).

Results: Twelve clinical trials, out of 9,867 titles, were included. HPMP improved DGF overall, as well as in DBDs and DCDs. The relative risks [RRs] were 0.79 (95% CI, 0.71-0.88), 0.85 (95% CI, 0.74-0.98), and 0.75 (95% CI, 0.61-0.92), respectively. There were no differences in PNF overall and for DBDs or DCDs. The RRs were 0.92 (95% CI, 0.73-1.16), 0.78 (95% CI, 0.22-2.73), and 1.13 (95% CI, 0.73-1.77), respectively. However, analysis with the better quality studies, overall RR for PNF was 0.62 (95% CI, 0.39-0.96). There were no differences between the graft function at 3 months after transplantation.

Conclusions: HPMP moderately improved the DGF results in grafts from cadaver donors of all types. HPMP could improve the PNF in grafts from DBDs, although more clinical trials are needed to prove that.