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CONTROLLABLE FACTORS THAT INFLUENCE GRAFT FUNCTION AND SURVIVAL.
Louise M. Jacobbi . Chicago IL, USA, Organ Recovery Systems,Inc, 60018, Organ Perfusion Division .

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Background: Considering the interest in mechanical preservation (MP) for kidney transplantation, particularly for kidneys from expanded criteria donors (ECK), we examined the impact of MP and donor and recipient risk factors on outcomes.
Methods: We reviewed data for 54,587 recipients of single cadaveric kidney transplants from 3/6/1995 to 6/30/2001 from the SRTR. The data were sorted by donor characteristics [traditional criteria (TCK) vs. ECK)] and preservation modality [non-machine perfused (NMP) vs. MP]. Primary outcomes were primary non-function (PNF), delayed graft function (DGF), and graft survival, and analyses were adjusted for recipient and donor risk factors.
Results: MP was associated with a reduced risk of DGF in both TCKs (OR=0.63) and ECKs (OR=0.57,) versus NMP. MP-treated kidneys had significantly lower risk of graft loss than NMP kidneys (RR=0.88), and ECKs derived the greatest survival benefit from MP (RR=0.82). ECKs after adjusting risk factors, associated with an increased risk of graft loss, the impact of MP on DGF was magnified (OR=0.53). MP had no effect on the incidence of PNF. When graft survival was adjusted for DGF, the protective effect of MP was removed suggesting that the protection provided by MP is likely due to preventing DGF, and/or that MP use is biased towards high risk ECKs. The recipient risk factors that correlated with an increase in DGF were >3 HLA mismatches (p value <.0001) and PRA >80 (p value <.0001).
Conclusion: Treatment with MP was associated with a reduction in the risk of DGF and graft loss. In all kidneys the rate of DGF was reduced by ~43%. Secondly, there was strong correlation between DGF in TCKs; the greater the number of HLA mismatches and the greater PRA level that was not seen in ECKs; suggesting that immunological issues play a lesser role in the outcome of these kidneys.