Priority 9 from the Kidney Transplant PSP

UNCERTAINTY: What techniques to preserve, condition and transport the kidney before transplantation allow increased preservation times and/or improve results?  (e.g. machine perfusion, normothermic reconditioning, addition of agents to perfusate)
Overall ranking Priority questions agreed on but not put in ranked order
JLA question ID 0037/9
Explanatory note Not available for this PSP

Existing Systematic Review: O'Callaghan, J. M., Morgan, R. D., Knight, S. R., Morris, P. J. Systematic review and meta-analysis of hypothermic machine perfusion versus static cold storage of kidney allografts on transplant outcomes. British Journal of Surgery. 2013;100(8):991-1001
Existing Randomised Controlled Trial: Nicholson ML1, Hosgood SA. Renal transplantation after ex vivo normothermic perfusion: the first clinical study. Am J Transplant. 2013 May;13(5):1246-52. doi: 10.1111/ajt.12179
Ongoing Randomised Controlled Trials: COPE-POMP: in house pre-implantation oxygenated hypothermic machine perfusion reconditioning after cold storage versus cold storage alone in expanded criteria donor (ECD) kidneys from brain dead donors. ISRCTN63852508~
COMPARDT: Cold Oxygenated Machine Preservation of Aged Renal Donation after cardiovascular death (DCD) Transplants. ISRCTN32967929.

Health Research Classification System category Renal and Urogenital
Extra information provided by this PSP
Original uncertainty examples

Can we reduce donor and preservation injury ? Does normothermic reconditioning of kidneys improve outcomes? Is normothermic reconditioning of deceased donor kidneys effective and cost-effective? Does machine preservation, either hypothermic or normothermic, improve outcome of donation after cardiovascular kidneys? What is the best way of preserving kidneys between the donor and recipient? Which of the new types of preservation and perfusion work best in giving better outcome for kidney transplant? - especially when other diseases in the donor might threaten kidney function. Does hypothermic machine preservation with oxygenation improve outcomes compared to hypothermic perfusion alone? How do we increase potential preservation time?

Comparison Devices
Submitted by Clinicians x 8
Outcomes to be measured Patient and graft survival, graft function, adverse events
PSP information
PSP unique ID 0037
PSP name Kidney Transplant
Total number of uncertainties identified by this PSP. 90  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 3 February 2016