Hindawi Publishing Corporation Journal of Transplantation Volume 2013, Article ID 802618, 7 pages http://dx.doi.org/10.1155/2013/802618 Research Article Hypothermic Machine Perfusion Preservation of the DCD Kidney: Machine Effects Susanne L. Lindell, 1 Heather Muir, 1 John Brassil, 2 and Martin J. Mangino 1,3,4 1 Departments of Surgery, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 23298-0454, USA 2 Functional Circulation, Northbrook, IL 60062, USA 3 Emergency Medicine, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 23298-0454, USA 4 Physiology and Biophysics, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 23298-0454, USA Correspondence should be addressed to Martin J. Mangino; mjmangino@vcu.edu Received 10 July 2013; Accepted 9 September 2013 Academic Editor: Parmjeet Randhawa Copyright © 2013 Susanne L. Lindell et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose. Kidneys from DCD donors represent a signiicant pool, but preservation problems exist. he study objective was to test the importance of machine type for hypothermic preservation of DCD kidneys. Methods. Adult Beagle dog kidneys underwent 45 minutes of warm in situ ischemia followed by hypothermic perfusion for 24 hours (Belzer-MPS Solution) on either an ORS LifePort or a Waters RM3 using standard perfusion protocols. Kidneys were then autotransplanted, and renal function was assessed over 7 days following contralateral nephrectomy. Results. Renal vascular resistance was not diferent between the two pumps. Ater 24 hours, the oxygen partial pressure and oxygen delivery in the LifePort perfusate were signiicantly lower than those in the RM3 but not low enough to change lactate production. heLifePort ran signiicantly colder than RM3 (2 ∘ versus 5 ∘ C). he arterial pressure waveform of the RM3 was qualitatively diferent from the waveform of the LifePort. Preservation injury ater transplantation was not diferent between the devices. When the LifePort was changed to nonpulsatile low, kidneys displayed signiicantly greater preservation injury compared to RM3. Conclusions. Both LifePort and RM3 can be used for hypothermic machine perfusion preservation of DCD kidneys with equal outcomes as long as the duty cycle remains pulsatile. 1. Introduction Renal transplantation continues to be the treatment of choice for patients with end stage renal disease. Currently, over 91,000 renal patients are wait listed to receive a kidney transplant while last year only 17% were transplanted [1]. While the wait list for kidneys seems to grow geometrically, the rate of transplantation grows linearly, leaving centers to look for new ways to expand the donor pool. One source of kidney donors that have gained con- siderable attention over the last decade is Donation ater Cardiac Death (DCD). he pool of controlled DCD kidneys is small since only about 10% of kidneys come from this category [2]. he pool for uncontrolled DCD kidney donors, however, is potentially huge. It has been estimated that of the 335,000 cardiac deaths that occurred in 2006, at least 22,000 (7%) may meet the criteria for uncontrolled DCD donation [3]. his has the conservative potential of unleashing 44,000 kidneys per year into the donor pool, which could seriously alleviate the donor shortage since the total number of all deceased donor kidney transplants in the USA in all of 2011 was only 11,043. Furthermore, the technical and logistic ability to use these kidneys is high in large cities that share both a major transplant center and a busy Emergency Medicine/Trauma service, thus making the theoretical implications for using uncontrolled DCD kidneys more realistic. However, the problem with using uncontrolled DCD kidneys is the necessary exposure of warm ischemia to the grats before harvest and preservation. While the efects of 30–90 minutes of warm renal ischemia per se produce