Factors Associated with the Use of Hypothermic Machine Perfusion in Kidney Transplant Recipients
Bibliographic record
Abstract
Background: Delayed graft function (DGF) is associated with an increased risk of graft loss. The use of cold hypothermic machine perfusion (HMP) has been shown to reduce the incidence of DGF in kidney transplant recipients (KTRs), especially when extended-criteria donors (ECDs) are used. However, there is a paucity of data on the determinants of HMP use in real-life setting. Methods: We aimed to determine the factors associated with the use of HMP in a cohort of donors and KTRs. We collected data on consecutive brain-dead donors admitted to an organ procurement organization and their KTRs between June 2013 and December 2018 in 5 adult transplant centers in Canada. There is no standardized protocol for the use of HMP in the province of Quebec. The use of HMP is left at the discretion of the surgeon recovering organs. However, a HMP device was available for every organ recovered at the organ procurement organization. Generalized estimating equations were used to predict the use of HMP. Results: The cohort included 159 deceased donors and their 281 KTRs. Thirty-three percent of donors were ECDs, and 59% of KTRs received organs placed on HMP. The median cold ischemia time (CIT) was 12.4 (IQR 7.9-16.2) hours. There were no differences in use of HMP over time. In univariate analysis, none of the donors' characteristics were associated with the use of HMP. The use of HMP was similar in ECD and standard criteria donors (33% vs 34%, p=0.82). For KTRs, in univariate analysis, race (non-Caucasian), cold ischemia time, use of basiliximab/alemtuzumab, and KTR center were associated with the use of HMP. In multivariate analysis, CIT (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.03-1.16) and KTR center were significantly associated with use of HMP. Conclusions: We found that use of HMP was strongly associated with the transplant center where the surgeons practiced, suggesting that surgeon preference/training plays an important role in determining the use of HMP. The presence of ECD did not influence the use of HMP. The reasons underlying the differences in practice between centers should be explored in further studies. Funding: Government Support - Non-U.S.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".