Clinical and Operational Evaluation of Hypothermic Machine Perfusion for Kidney Transplantation in a Brazilian Reference Center.

BACKGROUND

Hypothermic machine perfusion (MP) improves outcomes in kidney transplantation, but evidence from low- and middle-income countries (LMICs) and public health settings is limited. This study evaluated clinical and operational performances of MP in the first and largest Brazilian renal perfusion service.

METHODS

This single-center study was conducted at a Brazilian public hospital. Operational performance was evaluated through a qualitative observational analysis using a 20-item questionnaire applied to 7 transplant surgeons and perfusion nurses, based on national medical device assessment guidelines. Clinical outcomes were assessed in a longitudinal cohort of 212 deceased-donor kidney transplant recipients. Kidneys preserved with MP after an initial period of static cold storage (MP group, n = 100) were compared with those preserved exclusively with static cold storage (SCS group, n = 112). Outcomes included delayed graft function (DGF), dialysis requirement, length of hospital stay, and one-year graft and patient survival. Final data collection and analysis were completed in September 2025.

RESULTS

Operational evaluation was preponderantly favorable, supporting the sustainable use of MP, which was associated with a lower incidence of DGF compared with SCS (25% vs 46.5%; p = .002) and independently associated with lower odds of DGF (OR = 0,38; CI 95%: 0,21-0,69). MP recipients required fewer dialysis sessions and had shorter hospital stays. Graft function, rejection rates, and one-year graft and patient survival were similar between groups.

CONCLUSIONS

In a real-life LMIC public health setting, MP was operationally sustainable and reduced DGF after kidney transplantation, supporting its use in resource-constrained transplant programs.