Authors' objectives:

The aim of this review is to evaluate the clinical and cost-effectiveness of machine perfusion (MP), as opposed to cold storage (CS), as a means of preserving kidneys which are to be transplanted. It examines the use of MP for kidneys from both heart-beating donors (HBDs) and non-heart-beating donors (NHBDs), and the impact on graft function immediately post-transplantation as well as in the longer term. In addition, it examines whether or not the use of MP can allow valid testing of kidney viability prior to transplantation.

Authors' recommendations: The meta-analysis suggests that the use of MP, as compared with CS, is associated with a relative risk of DGF of 0.804 (95% confidence limits 0.672 to 0.961). There was no evidence to suggest that this effect is different in kidneys taken from HBDs as opposed to NHBDs. Meta-analysis of 1-year graft survival data showed no significant effect, but the studies, even when aggregated, were severely underpowered with respect to the likely impact on graft survival. The size of effects demonstrated were in line with those predicted by an indirect model of graft survival based on the association of DGF with graft loss. There is some evidence that the flow characteristics of the perfusate of kidneys undergoing MP may be an indicator of kidney viability, but data are inadequate to calculate the sensitivity and specificity of any test based on this. The concentration of alpha-glutathione-S-transferase (a marker of cell damage) in the perfusate may be the basis of a valid test. A threshold of 2800 micrograms/100 g gives a sensitivity of 93% and specificity of 33% (and hence a likelihood ratio of 1.41). The published economic evidence is of poor quality and the generalisability of the US studies to a UK healthcare setting is low. The economic assessment indicates that it is unlikely that in the UK health setting complete cost recovery will be obtained from a reduction in the incidence of DGF. The baseline analysis indicates that in the long-term MP would be expected to be cheaper and more effective than CS for both HBD and NHBD recipients. The probability that this is the case is estimated at around 80% for NHBD recipients and 5060% for HBD recipients.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.hta.ac.uk/1258

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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