Priority 9 from the Kidney Transplant PSP

UNCERTAINTY: What techniques to preserve, condition and transport the kidney before transplantation allow increased preservation times and/or improve results? (e.g. machine perfusion, normothermic reconditioning, addition of agents to perfusate)
Overall ranking	Priority questions agreed on but not put in ranked order
JLA question ID	0037/9
Explanatory note	Not available for this PSP
Evidence	Existing Systematic Review: O'Callaghan, J. M., Morgan, R. D., Knight, S. R., Morris, P. J. Systematic review and meta-analysis of hypothermic machine perfusion versus static cold storage of kidney allografts on transplant outcomes. British Journal of Surgery. 2013;100(8):991-1001 Existing Randomised Controlled Trial: Nicholson ML1, Hosgood SA. Renal transplantation after ex vivo normothermic perfusion: the first clinical study. Am J Transplant. 2013 May;13(5):1246-52. doi: 10.1111/ajt.12179 Ongoing Randomised Controlled Trials: COPE-POMP: in house pre-implantation oxygenated hypothermic machine perfusion reconditioning after cold storage versus cold storage alone in expanded criteria donor (ECD) kidneys from brain dead donors. ISRCTN63852508~ COMPARDT: Cold Oxygenated Machine Preservation of Aged Renal Donation after cardiovascular death (DCD) Transplants. ISRCTN32967929.
Health Research Classification System category	Renal and Urogenital

Extra information provided by this PSP
Original uncertainty examples	Can we reduce donor and preservation injury ? Does normothermic reconditioning of kidneys improve outcomes? Is normothermic reconditioning of deceased donor kidneys effective and cost-effective? Does machine preservation, either hypothermic or normothermic, improve outcome of donation after cardiovascular kidneys? What is the best way of preserving kidneys between the donor and recipient? Which of the new types of preservation and perfusion work best in giving better outcome for kidney transplant? - especially when other diseases in the donor might threaten kidney function. Does hypothermic machine preservation with oxygenation improve outcomes compared to hypothermic perfusion alone? How do we increase potential preservation time?
Comparison	Devices
Submitted by	Clinicians x 8
Outcomes to be measured	Patient and graft survival, graft function, adverse events

PSP information
PSP unique ID	0037
PSP name	Kidney Transplant
Total number of uncertainties identified by this PSP.	90 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	3 February 2016