DOI: 10.1097/txd.0000000000002005 ISSN: 2373-8731

Effects of End-ischemic Hypothermic Oxygenated Perfusion on 1-y Graft Function in Kidney Transplantation: A Real-world, Single-center Analysis From the United States

Justin A. Steggerda, Tiffany Lim, Irene K. Kim, Tsuyoshi Todo, Edmund Huang, Todd V. Brennan, Georgios Voidonikolas, Alice Peng, Reiad Najjar, Jun Shoji, Stanley Jordan, Sindhu Chandran, Emma Crichton, Benjamin Ferrel, Jose Reyes-Perez, Manaf Alsudaney, Peter S. Heeger, Steven A. Wisel
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Background.

Hypothermic oxygenated perfusion (HOPE) supplies oxygen to kidney allografts for resuscitation before transplantation and may improve graft recovery. This study represents the first U.S.-based comparative analysis evaluating the impact of HOPE on kidney transplant (KT) outcomes.

Methods.

A retrospective, single-center study of adult, deceased-donor, kidney-only transplants performed between December 1, 2023, and March 31, 2025. Transplants were grouped according to preservation method: HOPE, static cold storage (SCS), or hypothermic machine perfusion (HMP) without oxygen alone. The primary outcome was 12-mo estimated glomerular filtration rate (eGFR). Subgroup analyses were performed, including donation after circulatory death (DCD) and long cold ischemic time (>18 h) KT. A matched cohort analysis was performed for DCD-KT. Kruskal-Wallis rank-sum and pairwise comparisons were used. P -values of <0.05 were considered significant.

Results.

Among 279 KT, 137 (49.1%) used SCS, 56 (20.1%) HOPE, and 86 (30.8%) HMP. There were few differences in baseline characteristics between groups, including donor age, kidney donor profile index, donor serum creatinine, and recipient age. Preservation time was significantly longer with HOPE (median 27.9 versus SCS 18.3 versus HMP 20.2 h; P  < 0.001). At 12 mo post-KT, HOPE demonstrated higher median eGFR compared with HMP (63 versus 53 mL/min; P  = 0.019) and similar to SCS (63 versus 62 mL/min; P  = 0.96). In a matched DCD-KT analysis, HOPE outperformed HMP (67 versus 48 mL/min; P  = 0.034). HOPE also showed improved eGFR compared with HMP for KT with cold preservation times >18 h (64 versus 52 mL/min; P  = 0.011).

Conclusions.

HOPE preservation is associated with improved long-term graft function compared with HMP while maintaining outcomes compared with SCS despite longer preservation times, with notable benefits in DCD-KT.

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