Machine perfusion <i>versus</i> cold storage in renal preservation of deceased donors with brain death: systematic review and meta-analysis.

Leite, Ricardo Ribas de Almeida; Schanaider, Alberto; da-Fonseca, Eliana Rosa; Xavier, Vinicius Layter; de-Miranda, Luiz Carlos Duarte

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Review Article • Rev. Col. Bras. Cir. 46 (2) • 2019 • https://doi.org/10.1590/0100-6991e-20192079 copy

Machine perfusion versus cold storage in renal preservation of deceased donors with brain death: systematic review and meta-analysis.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

With the increasing use of machine perfusion in kidney transplantation, it has been observed that dynamic ischemia correlates with the improvement of organ preservation. In this context, we performed a systematic review that aimed to evaluate the efficacy of the portable machine perfusion (LifePort Kidney Transporter Machine®), used in Brazil, compared to cold storage, regarding the delayed graft function of deceased donors with brain death. Literature search was carried out in LILACS, MEDLINE via PubMed, Scopus, Clarivate Analytics, Cochrane Library, Embase, and SciELO, as well as in Google Scholar manually. The systematic review consisted only of randomized clinical trials. For meta-analysis, relative risk and odds ratio were evaluated. Eighty-six documents were identified and two papers from European and Brazilian groups were selected at the end, with eligibility criteria for meta-analysis. In these, 374 kidneys were assigned to machine perfusion and 374 kidneys were assigned to cold storage. Delayed graft function was observed in 84 and 110 patients, respectively. In meta-analysis, a risk ratio of 0.7568 (p=0.0151) and an odds ratio of 0.6665 (p=0.0225) were obtained, both with a 95% confidence interval. Machine perfusion reduced the incidence of delayed graft function of deceased donors with brain death.

Keywords:
Kidney Transplantation; Pulsatile Flow; Cold Ischemia; Delayed Graft Function; Brain Death.

	Descriptors/Synonyms	MeSH terms/Entry terms
Patient	“Kidney Transplant” OR “Kidney Graft” OR “Renal Transplant” OR “Kidney Transplantation” OR “Renal Transplantation”	“Kidney Transplantation” OR “Renal Transplantation” OR “Renal Transplantations” OR “Transplantations Renal” OR “Transplantation Renal” OR “Grafting, Kidney” OR “Kidney Grafting” OR “Transplantation Kidney” OR “Kidney Transplantations” OR “Transplantations Kidney”.
Intervention	“Machine Perfusion”	“Kidney Perfusion” OR “Machine Perfusion in Kidney” OR “Machine Perfusion” OR “Renal Perfusion” OR “Perfusion Machines”.
Intervention	“Pulsatile Flow” OR “Pulsatile Perfusion”	“Pulsatile Flow” OR “Pulsatile Flow” OR “Flow Pulsatile” OR “Flows Pulsatile” OR “Pulsatile Flows” OR “Flow Pulsating” OR “Flows Pulsating” OR “Pulsating Flow” OR “Pulsating Flows” OR “Perfusion Pulsatile” OR “Perfusions Pulsatile” OR “Pulsatile Perfusion” OR “Pulsatile Perfusions” OR “Static Storage”.
Comparison	“Cold Ischemia” OR “Cold-Induced Ischemia”	“Cold Ischemia” OR “Ischemia Cold” OR “Cold Ischemia Time” OR “Cold Ischemia Times” OR “Time Cold Ischemia” OR “Cold Ischemic Time”.
Outcome	“Delayed Graft Function”	“Delayed Graft Function” OR “Graft Function, Delayed”.

Databases	Search strategies
PubMed	(((("kidney transplantation"[MeSH Terms] OR ("Kidney Transplantation"[Title/Abstract] OR "Renal Transplantation"[Title/Abstract] OR "Renal Transplantations"[Title/Abstract] OR "Transplantation Renal"[Title/Abstract] OR "Kidney Grafting"[Title/Abstract] OR "Transplantation Kidney"[Title/Abstract] OR "Kidney Transplantations"[Title/Abstract] OR "Transplantations Kidney"[Title/Abstract])) AND (("pulsatile flow"[MeSH Terms] OR ("Pulsatile Flow"[Title/Abstract] OR "Pulsatile Flow"[Title/Abstract] OR "Flow Pulsatile"[Title/Abstract] OR "Pulsatile Flows"[Title/Abstract] OR "Pulsating Flow"[Title/Abstract] OR "Pulsating Flows"[Title/Abstract] OR "Perfusion Pulsatile"[Title/Abstract] OR "Pulsatile Perfusion"[Title/Abstract] OR "Pulsatile Perfusions"[Title/Abstract])) OR ("kidney perfusion"[Title/Abstract] OR "Machine Perfusion"[Title/Abstract] OR "Renal perfusion"[Title/Abstract] OR "perfusion machines"[Title/Abstract]))) AND ("delayed graft function"[MeSH Terms] OR ("Delayed Graft Function"[Title/Abstract] OR DGF[Title/Abstract]))) AND (English[lang] OR Portuguese[lang] OR Spanish[lang])) AND ((clinical[Title/Abstract] AND trial[Title/Abstract]) OR "clinical trials as topic"[MeSH Terms] OR clinical trial[Publication Type] OR random[Title/Abstract] OR "random allocation"[MeSH Terms] OR "randomized controlled trial"[All Fields] OR "clinical trial"[Title/Abstract] OR "prospective trial"[Title/Abstract] OR "randomized trial"[Title/Abstract]) AND (English[lang] OR Portuguese[lang] OR Spanish[lang]).
Scopus	((((TITLE-ABS-KEY("Kidney Transplantation" OR "Renal Transplantation" OR "Renal Transplantations" OR "Transplantations Renal" OR "Transplantation Renal") OR TITLE-ABS-KEY("Grafting, Kidney" OR "Kidney Grafting" OR "Transplantation Kidney" OR "Kidney Transplantations" OR "Transplantations Kidney"))) AND ((TITLE-ABS-KEY("kidney perfusion" OR "machine perfusion in kidney" OR "Machine Perfusion" OR "Renal perfusion" OR "perfusion AND machines) OR TITLE-ABS-KEY("Pulsatile Flow" OR "Pulsatile Flow" OR "Flow Pulsatile" OR "Flows Pulsatile" OR "Pulsatile Flows" OR "Flow Pulsating") OR TITLE-ABS-KEY("Flows Pulsating" OR "Pulsating Flow" OR "Pulsating Flows" OR "Perfusion Pulsatile" OR "Perfusions Pulsatile" OR "Pulsatile Perfusion" OR "Pulsatile Perfusions"))) AND (TITLE-ABS-KEY("Delayed Graft Function" OR "Graft Function Delayed" OR dgf))) AND (TITLE-ABS-KEY("clinical trial" OR "clinical trials"))) AND (TITLE-ABS-KEY("circulatory death" OR "cardiac death")).
Clarivate Analytics (Web of Science)	("Kidney Transplantation" OR "Renal Transplantation" OR "Renal Transplantations" OR "Transplantations Renal" OR "Transplantation Renal" OR "Grafting, Kidney" OR "Kidney Grafting" OR "Transplantation Kidney" OR "Kidney Transplantations" OR "Transplantations Kidney") AND Topic: ("Pulsatile Flow" OR "Pulsatile Flow" OR "Flow Pulsatile" OR "Flows Pulsatile" OR "Pulsatile Flows" OR "Flow Pulsating" OR "Flows Pulsating" OR "Pulsating Flow" OR "Pulsating Flows" OR "Perfusion Pulsatile" OR "Perfusions Pulsatile" OR "Pulsatile Perfusion" OR "Pulsatile Perfusions") AND Topic: ("Delayed Graft Function" OR "Graft Function Delayed" OR DGF) AND Topic: ("clinical trial" OR "clinical trials" OR "random allocation") Stipulated time: every year. Indexes: SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, and ESCI.
Cochrane	ID Search Hits #1 "Kidney Transplantation":ti,ab,kw or "renal transplantation":ti,ab,kw or "Transplantations Renal":ti,ab,kw or "Kidney Transplantations":ti,ab,kw or "Kidney Grafting":ti,ab,kw (Word variations have been searched) 6873 #2 "Machine Perfusion":ti,ab,kw or "perfusion machines":ti,ab,kw or "pulsatile flow":ti,ab,kw or "Pulsatile Flows":ti,ab,kw or "Flow Pulsatile":ti,ab,kw (Word variations have been searched) 630 #3 "delayed graft function":ti,ab,kw or "Graft Function Delayed":ti,ab,kw or "DGF":ti,ab,kw (Word variations have been searched) 385 #4 #1 and #2 and #3 28 There are 25 results from 1039010 records for your search on #4 - #1 and #2 and #3 in Trials in the strategy currently being edited.
Embase	'Kidney transplantation' AND ('pulsatile flow' OR 'machine perfusion') AND 'delayed graft function' AND ('clinical trial' OR randomization) 'kidney transplantation'/de AND 'machine perfusion'/exp AND 'delayed graft function'/exp AND 'machine perfusion' AND ('clinical trial'/exp OR 'clinical drug trial' OR 'clinical trial' OR 'major clinical trial' OR 'trial, clinical').

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[1] Mailing address: Ricardo Ribas de Almeida Leite E-mail: ribasricardo@yahoo.com.br