Pulsatile Perfusion Reduces the Risk of Delayed Graft Function in Deceased Donor Kidney Transplants, Irrespective of Donor Type and Cold Ischemic Time

Background The role of pulsatile perfusion (PP) across different cold ischemic times (CIT) within different donor groups is unclear. This study examined the association of PP with delayed graft function (DGF) in all (n=94,709) deceased donor kidney transplants in the US between 2000 and 2011, as a function of CIT and donor type. Methods Using the Scientific Registry of Transplant Recipients data, all adult standard criteria donors (SCD, n=71,192), expanded criteria donors (ECD, n=15,122), and donors after circulatory death (DCD, n=8,395) kidney transplant recipients were identified. Within each donor group, transplants were stratified based on duration of CIT: 0 to 6 hours, 6.1 to 12 hours, 12.1 to 18 hours, 18.1 to 24 hours, 24.1 to 30 hours, 30.1 to 36 hours, and greater than 36 hours. Within each group, the odds of DGF with and without PP was determined after adjusting for donor, recipient, and transplant factors, including a propensity score for the likelihood of PP use, and clustering on transplant center using multivariable logistic regression. Results When stratified by donor type and CIT, the adjusted odds of DGF were lower with PP across all CIT in SCD transplants, when CIT was greater than 6 hours in ECD transplants, and when CIT was between 6 and 24 hours in DCD transplants. CIT was independently associated with a greater risk of DGF irrespective of storage method, but this effect was substantially modified by PP. Conclusion PP is associated with a reduced risk of DGF irrespective of donor type and CIT. Although PP modifies the impact of CIT on the risk of DGF, it does not eliminate its association with DGF, suggesting the optimal strategy to reduce DGF is to minimize CIT and utilize PP in all deceased donor transplants.