Perfusion Parameters of Donation After Cardiac Death Kidneys Predict Early Transplant Outcomes Based on Expanded Criteria Donor Designation

Background: Donation after cardiac death is the only source of the deceased donor in China at present. Hypothermic machine perfusion has been used increasingly over the years. We determined the hypothermic machine perfusion parameters associated with early transplant outcomes based on the expanded criteria donor (ECD) designation. Methods: There were 446 consecutive kidneys donated after cardiac death and preserved by hypothermic machine perfusion (LifePort) in our center that were included in this study. The database was divided into 2 groups: ECD and non-ECD groups. LifePort parameters and other pretransplant factors were analyzed. Logistic regression analysis was used to determine the significant factors for delayed graft function (DGF). Recovery time for renal function and 6-months serum creatinine were investigated. Results: The DGF rates were 20.25% and 11.72% in ECD and non-ECD group by our definition, respectively (P =.042). Higher pressures allowed comparable increases of flow in ECD kidneys despite still greater resistance. For non-ECD kidneys with an initial flow of ≤80 mL/min, the DGF rate of the subgroup with a terminal flow of ≥100 mL/min was significantly lower compared with that of other terminal flow subgroups (≤80 and 90–100 mL/min; P <.05), and showed a trend toward significance when compared with the terminal flow subgroup of 80 to 90 mL/min (P =.098). Terminal resistance was the most significant parameter predicting DGF (odds ratio 2.44; P <.001), and remained significant after adjusted for other relevant pretransplant variables. Logistic model for DGF (model: terminal resistance, hypotension in agonal phase, terminal serum creatinine, and cause of death) had good predictive ability (c-statistic 0.851; 95% confidence interval, 0.799–0.903). Conclusions: LifePort parameters provided a granular measurement easily accessible in evaluating the quality of kidneys donated after cardiac death that added information to ECD criterion.