SRS241 - Machine perfusion for deceased donor kidney transplantation: network meta-analysis of the Cochrane review

Abstract Background In deceased donor kidney transplantation, the process of donation, transportation and transplantation exposes grafts to ischemia-reperfusion injury (IRI). Machine perfusion (MP) has increased in popularity to ameliorate IRI compared to conventional static cold storage (SCS). Perfusion preservation can be performed at different temperatures (hypothermic versus normothermia), with or without oxygen, either during transport plus at the recipient centre (continuous) or only at the recipient centre (end-ischemic). This study assessed the effectiveness of various MP strategies on kidney transplant outcomes. Methods This Bayesian network meta-analysis (NMA) included randomised trials from our recent Cochrane review that specified the MP type and timing (continuous versus end-ischemic). NMA allows comparisons across multiple interventions even without direct head-to-head trials. Rankograms were used to obtain the probability of each intervention occupying specific ranks. Results Oxygenated continuous hypothermic MP (cHMPO2) was the top-ranked technique for 1-year graft survival (probability of cHMPO2 being rank 1 = 92%; probability of cHMP being rank 2 = 80%), delayed graft function and acute rejection, followed by non-oxygenated cHMP. Results for patient survival and primary non-function were less certain due to small number of events and resulting imprecision. In contrast, oxygenated end-ischemic HMP (eiHMPO2) and end-ischemic normothermic MP (eiNMP) showed no clear benefit over SCS for any outcome. Conclusions cHMPO2 was consistently ranked as the most effective renal ex-situ machine perfusion strategy across multiple outcomes. However, head-to-head trials comparing cHMPO2 and cHMP in DBD and younger DCD transplants are needed, as current randomised evidence is limited to older DCD transplants.