NATIONAL IMPACT OF PULSATILE PERFUSION ON CADAVERIC KIDNEY-TRANSPLANTATION

Background. The simplicity and success of cold storage of cadaveric ki dneys have led to the infrequent use of pulsatile perfusion. However, there may be advantages to pulsatile perfusion for less optimal donors , Methods. United Network for Organ Sharing data were analyzed retrosp ectively to determine the impact of pulsatile perfusion on initial fun ction and 1-year graft survival. The analysis included 60,827 cadaveri c kidney transplants performed between 1988 and 1995, Multivariate log istic regression analyses were used to determine the effect of preserv ation method on both early kidney function (need for first-week dialys is after transplant) and 1-year graft survival, after adjusting for ot her known risk factors, Results. The preservation method exhibited a h ighly significant impact on the need for first-week dialysis, Ice-pres erved kidneys were associated with a 2.13-fold increase in the odds of requiring dialysis compared with perfused kidneys, If the donor age w as greater than or equal to 55 years, the odds were 2.33-fold higher f or ice-preserved as compared with perfused, If cold ischemic time was greater than or equal to 24 hr, there was a 2.19-fold increase in the odds of dialysis for ice-preserved kidneys, African-American recipient s of cold-stored kidneys had a 2.29-fold greater odds of first-week: d ialysis, Conclusions. Based on these findings, it was estimated that t he increased cost of perfusing kidneys from all donors greater than or equal to 55 years of age would be balanced by the decreased need for posttransplant dialysis if the cost related to dialysis were $14,700 o r greater per patient. These facts, coupled with the ability to assess an older donor kidney before transplant, could make pulsatile perfusi on for the expanded donor financially as well as medically desirable.