Extending Preservation in Pediatric Kidney Transplantation: First Contemporary Experience With Hypothermic Oxygenated Machine Perfusion

INTRODUCTION: Hypothermic machine perfusion currently represents the gold standard preservation modality for kidneys retrieved from adult deceased donors, with reduced delayed graft function (DGF) rates and improved early transplant survival compared to static cold storage (SCS). To date, clinical experience with hypothermic oxygenated machine perfusion (HOPE) in pediatric kidney transplants (KT) setting remains extremely limited. METHODS: We conducted a single-center retrospective analysis of pediatric KT recipients preserved using HOPE. Between November 2019 and December 2023, 129 pediatric kidney transplants were performed at our institution. After exclusion of living donor transplants (n = 37), 92 recipients were included: 40 grafts preserved using HOPE and 52 using SCS. Clinical outcomes, graft function, and survival were compared between groups. RESULTS: The study cohort consisted mainly of male (59.8%), with a mean recipient age of 12.6 ± 5.9 years. Baseline donor and recipient characteristics were comparable between groups. Despite a significantly longer total cold preservation time (CPT) in the HOPE group (23.7 ± 4.1 vs. 13.3 ± 3.7 h; p < 0.001), no significant differences were observed in the incidence of DGF, biopsy-proven acute rejection, postoperative length of stay, or graft function up to 1 year. One-year death-censored graft survival was 97% in the HOPE group and 98% in the SCS group, with no significant difference between preservation strategies. CONCLUSION: In this first clinical experience with HOPE in pediatric KT, oxygenated hypothermic perfusion proved to be safe and feasible, even in the setting of prolonged CPT. The implementation of HOPE programs could improve the logistical management of pediatric donors and recipients without compromising transplant results.