Introduction: Robust scientific evidence demonstrates that preserving kidneys from deceased donors (DD) with hypothermic machine perfusion (HMP) promotes a significant reduction in the incidence of Delayed Graft Function (DGF), defined as the need for dialysis in the first 7 days post-transplant. DGF has been associated with the occurrence of complications such as rejection, increased length of hospital stay and lower survival rates for both grafts and patients. However, this technology is not yet widely used in Latin America, and there are few publications on the use of HMP for pediatric kidney recipients.
Objectives: This study aims to evaluate the use of HMP in DD kidneys for pediatric transplantation and compare the outcomes with those of static cold storage (SCS) in short and long-term post-transplant scenarios among Brazilian children.
Methods: This retrospective cohort study analyzed data from all pediatric recipients of DD kidney transplants performed between June 2012 and June 2023 in a Brazilian public hospital and was approved by the local Ethics Committee. The exposure factor in this longitudinal observational analysis was the use of HMP to preserve kidney grafts. Data were collected by a systematic review of medical charts and electronic databases. Patient records and information was anonymized and de-identified before analysis. All deceased donors were brain-dead and next of kin provided written informed consent that was freely given.
Results: Medical records of 226 kidney transplanted children whose grafts had been kept only in SCS (n=118) or in HMP (n=108) before surgical implantation were reviewed. Among the etiologies of chronic kidney disease, glomerulopathies (36%) and urological pathologies (27%) were the most frequent causes of kidney failure. Regarding DD, traumatic brain injury was the most prevalent cause of death (71%) and the average age was 15.9 years. Among clinical outcomes, DGF stood out in 30% of transplanted children whose grafts had been placed in SCS while it was observed in only 11% of children whose transplanted kidneys had been preserved in HMP.
Conclusions: In this study, HMP kidney preservation proved to be a protective factor against DGF and its harmful consequences, such as longer hospital stays, in pediatric patients undergoing kidney transplantation.