PERFUSION PARAMETERS IN PREDICTING OUTCOMES OF MACHINE PRESERVED KIDNEYS

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P27 Aims: The perfusion parameters (PP) of Perfusate Flow rates (F) and the calculated Renal Resistance index (RR) have been used to predict the function of the perfused kidney after transplantation and to make decisions regarding transplantation or discard of the kidney. Thus, understanding the correlation between PP and subsequent outcome is critical in optimizing the utilization of deceased donor kidneys. Methods: We have analyzed these correlations for 250 consecutive perfused kidneys. Only kidneys from expanded donors were preserved by continous pulsatile perfusion. The donor criteria included age ≥60; Age 50-59 with one of the following: Hx of DM or HTN; admit S. Creat. ≥1.5 or calculated GFR < 70. Doubling of S. Creat (admit to final) and DCD donors. The Waters RM-3 apparatus and Belzer MPR solution were used. Pump pressures (P) were initially set at 60mmHg. Flow rates were measured by the RM-3 flow probes and RR was calculated in the standard fashion using the formula: RR= (Psyst + Pdiast × 2) / 3 × F (ml/min). Post-transplant follow up of renal function was obtained on all 184 transplanted kidneys out to 6 months. Delayed graft function (DGF) was defined as the use of dialysis in the first week. Results: There were 130 Immediate function (IF), 50 DGF and 4 Primary None Function (PNF) kidneys (with transplant related complications in 2/4). 66 kidneys were discarded. The mean 2 hour and 4 hour F did not differ between IF, DGF and PNF kidneys (113±37.1, 116±31.5, 103±39 and 112±35.7, 118±30, 112±41 respectively). The corresponding RR for these time frames did not differ : (.28±.1, .27±.12, .41±.22 and .27±.1, .26±.1,.37±.21 respectively). The comparison of 15 mate (same donor) kidneys with different initial function did not indicate differences in PP between the the IF and DGF kidneys. The F and RR for the 36 kidneys where PP was (at least in part) the reason for kidney discard were significantly different (p<.001) from both the IF and DGF kidneys (75±17 and .50±.18 at 2 hrs and 75±19 and .48±.18 at 4 hours.) Although biopsy findings were a factor in the decision to discard in the majority of these 36 kidneys, using the PP parameter data of the transplanted kidneys suggests a potential for significantly decreasing the discard rate in this group. Summary and Conclusions: Standard Perfusion Parameters (PP) cannot be reliably used to predict early renal function after transplantation. Kidneys with F >60 and RR <0.6 should not be discarded based on PP alone. More sophisticated indicators for predicting PNF are needed.

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