Evaluation of quality of kidneys from donation after circulatory death/expanded criteria donors by parameters of machine perfusion

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Shortage of deceased donors is a major problem in the kidney transplant field. In China, this situation is more severe, because donors from executed prisoners have been abandoned gradually in China in recent years.1 Donation after circulatory death (DCD) has become a major source of deceased donors due to brain death laws not being approved in China.2 The DCD donors have longer warm ischaemia time, and usually have higher incidence of delayed graft function (DGF) and primary non‐function (PNF) after kidney transplant compared to standard criteria donors (SCD).3 Within the DCD donors, there are some expanded criteria donors (ECD) with old age, hypertension history, or high serum creatinine levels before donation. Combined DCD and ECD donors have even poorer outcomes after transplant.4 How to evaluate the quality of DCD/ECD kidneys before kidney transplant and decide whether or not to discard kidneys is a critical problem for kidney transplant surgeons. Kidney biopsy has been used as a gold standard for evaluating quality of kidneys before transplant by far. However, kidney biopsy is a time‐consuming and injurious process, and experienced pathologists are needed for evaluating the kidney quality. Machine perfusion has been widely used in preserving DCD or ECD kidneys in recent years.5 Some parameters of machine perfusion have been reported to correlate with the DGF rate after kidney transplant,7 therefore machine perfusion may be a promising non‐invasive tool for evaluating kidney quality before transplantation. In this study, we collected data of 58 DCD/ECD kidneys preserved with machine perfusion (Life Port Chicago, IL, USA) in our hospital, with the aim to investigating whether the parameters of machine perfusion could predict the quality of kidneys from DCD/ECD donors.
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