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P-4.76 Using pulsatile perfusion to successfully transplant kidneys with 15 percent glomerulosclerosis


Using pulsatile perfusion to successfully transplant kidneys with 15 percent glomerulosclerosis

Marty Sellers1,2, Lee Langley2, Paula Lawrence3, David Marshman3, Dustin Diggs2, Jean Davis3.

1Emory University, Atlanta, GA, United States; 2LifeLink of Georgia, Norcross, GA, United States; 3LifeLink Foundation, Tampa, FL, United States

Purpose: Transplantable kidneys are too often discarded, partially due to the inefficiency of our allocation system, and partially due to uncertainty of their quality, especially if a biopsy shows ≥15% glomerulosclerosis (GS). Pulsatile perfusion (PP) of kidneys allows a semi-physiologic evaluation of their quality; it also results in decreased delayed graft function (DGF) of those eventually transplanted. We developed a strategy of PP for all ≥51%-KDPI kidneys in 2018 to see if showing favorable pump metrics (flow, resistance) would lead to fewer kidneys discarded.
Methods: PP was planned for 1 year in all ≥51%-KDPI kidneys, beginning June 1, 2018. If an accepting center requested, kidneys were not preserved with PP. We compared our acceptance for the 12 months post-implementation with our experience 2 years pre-implementation. Recipient 6- and 12-month (if follow-up allowed) creatinines were also recorded.
Results: 568 kidneys were recovered for transplant and 243 preserved with PP, 59 (10.4%) of these also had KDPI ≥51% and GS ≥15% (range 15-30%). 31 (52.5%) of these were preserved with PP; the other 28 were discarded. 9 (29%) of the 31 PP kidneys were transplanted into 8 recipients. The average recipient 6-month creatinine was 1.7 (range 0.89-3.71); 6 recipients have at least 12-months follow-up with a mean creatinine = 1.76 (range 0.89-4.4); 5 of these had a creatinine less than 1.6. DGF was reported in 2 (25%) of the recipients. In the 2 years pre-PP, we only had 2 of 44 kidneys with 51% KDPI/15% GS transplanted (p=0.0005) without PP; 8 others were exported and transplanted after PP at the accepting center.
Conclusion: PP enhances the ability of OPOs to place kidneys from donors with biopsies showing ≥15% GS. Moreover, these kidneys work well for the majority of recipients. Further studies are needed to refine the PP parameters to predict which kidneys will provide long term dialysis independence.


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