Ischemia time on renal graft survival: Efficacy of machine perfusion

EXECUTIVE ABSTRACT

Intensity of recommendations: Weak against the technology

Technology: Machine perfusion for human kidneys obtained from living or cadaveric donors for transplantation Indication: Kidney storage for transplantation

Characterization of the technology: The machine perfusion involves a hypothermic infusion pulsatile pump, which provides oxygen and nutrients through a specific solution for kidney preservation while removes waste products in an attempt to mimic the circulation.

Question: Renal perfusion machines are effective in ensuring greater graft survival and patient survival?

Search and analysis of scientific evidence: We searched Medline (via Pubmed), Centre for Reviews and Dissemination (CRD), The Cochrane Library, EMBASE, and LILACS databases for systematic reviews (SR) of clinical trials that compared machine perfusion and static cold storage for renal graft preservation. We searched Health Technology Assessments (HTA) in sites of international agencies and the Brazilian Network for Health Technology Assessment. Quality of the evidence and strength of recommendation were evaluated using the GRADE system

Summary of results of selected studies: We included eight studies: five SR and three HTA. SR did not show statistically significant differences in graft survival, patient survival and primary non-function between static cold storage and machine perfusion groups. Patients who received grafts stored in machine perfusion showed better results in regard to delayed graft function. Most RS showed poor quality evidence, and all lead to a weak recommendation against the technology. The three HTA corresponded to recommendations of two agencies, one in favor of the machine perfusion use and the other left the choice of the storage method in discretion of the institution.

Recommendations: To date there is no sufficient and quality evidence to support the use of kidney preservation machine nationwide. Although there are not a substitute for this technology (the gold standard is the static cold storage), the studies did not show results that represent a gain in graft and patient survival.

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