Korean J Transplant.  2023 Nov;37(Suppl 1):S74. 10.4285/ATW2023.F-6516.

Overcoming the most prolonged cold ischemia time in Korea using hypothermic machine perfusion in deceased donor kidney transplantation

• Chang WB
• Shin YH
• Ko T

• KMID: 2551661
• DOI: http://doi.org/10.4285/ATW2023.F-6516

Abstract

To overcome the scarcity of donor kidneys, marginal grafts have become more prevalent in deceased donor kidney transplantation (DDKT). But they correlate with the inferior outcomes, especially in the case with prolonged cold ischemia time (CIT). Hypothermic machine perfusion (HMP) during graft transportation has been studied as a way to overcome prolonged CIT. We report a case to overcome the longest CIT in Korea using hypothermic machine perfusion (HMP) in DDKT. Donor was a 54-year-old male (Kidney Donor Profile Index [KDPI] 82%) with diabetes. The recipient was a 51-year-old male on peritoneal dialysis, who was end-stage renal disease due to diabetes nephropathy. After procurement, the left kidney was preserved in HMP. Due to the weather issues, the kidney graft was delayed for transportation, total CIT was 28 hours 6 minutes (HMP time: 22 hours 35 minutes). Antithymocyte globulin was given as induction therapy, and the same maintenance immunosuppressants (tacrolimus, mycophenolate mofetil, steroid) were used for the recipient. Postoperative graft function gradually recovered in the patient without problems. Urine output also showed descent amount. The patient showed no sign of delayed graft function (DGF), and were discharged on postoperative day 13 without significant complications. The successful DDKT using a marginal donor graft with the longest CIT by using HMP demonstrates the usefulness of HMP in improving graft quality and in preserving graft function.