The authors concluded that then, the survival of kidneys post DBD remained
significantly higher after MP than after SCS as mode of preservation. This was
more apparent in kidneys coming from ECD.
those controversies in the available studies emphasized the significance of
further studies in order to answer above questions. As mentioned only
the first large multi-centred randomised control trial (RCT)of SCS versus MP
(Eurotransplant) produced level A evidence that MP is linked with shorter
length of DGF and enhanced graft survival at 1 year. Another worth to mention
RCT was performed by Watson et al. It showed contradictory to Eurotrasplant
trial findings 18.
To my understanding an important point when
attempting to compare Moers and Watson studies is the variance in the point of
starting MP. In Watson study the kidneys that underwent MP initially had a
period of CS of several hours prior to being transported to the laboratory for
commencing MP 18. On the other hand, in Eurotransplant trial the kidneys of
the MP group were perfused as soon as possible after their retrieval. This
might imply the importance of commencing MP immediately rather than with time
et al in the USA analysed date from the USA found that MP is superior as it
reduces significantly the requirement for dialysis during the first week. 19.
Moreover, Wight et al meta-analysis in 2003 showed that MP could decrease DGF
up to 20% 20. Furthermore, a retrospective analysis of 25.000 kidney
transplantations from the USA registry showed improved rates of DGF and graft
survival in MP groups 21. On the other hand, Bond et al concluded that MP
compared to SCS only improved 1-year graft survival but did not affect DGF 22.
another meta-analysis that included 18 studies and 2203 kidneys suggested that
HMP when compared to SCS resulted in better immediate graft function post
transplantation and improved graft survival rates. 23 The largest relevant
meta-analysis so far was performed by Hameed et al and included 101 studies (63
human and 38 animal) 24. It was strongly confirmed that there was lower probability
of DGF when HMP was selected compared to CS and PNF was also less common in MP
ECD kidneys. Also, they concluded that
HMP improved the short-term outcomes post renal transplantation however they
were less confident to support similar benefits in long term 24.
is still an imperative need for further research in this area. Lots of
questions require answers. These are the ideal MP times, the role of
oxygenation, ideal MP solutions, use of potential additives etc. Organ preservation has been described
as ‘the supply line for organ transplantation’ 25 and logistically
it does buy time, which is crucial to organise staff and facilities,
transport organs, and perform necessary laboratory tests.