Dr. John Fung, director of transplant services at the Cleveland Clinic, did his own financial analysis, which was not favorable for perfusion.
"To pump a kidney costs about $1,000 to $1,500," Fung said. "Is that added cost going to be offset by the benefits? If you look at the data, the reduced cost of dialysis and better survival at one year, they didn't answer that question."
The study will not change the Cleveland Clinic's use of perfusion, which is limited, Fung said. "We use cold storage for most kidneys," he said. "We use the pump for those kidneys we are not so sure about -- from older donors, those where the kidney function may not be as good, for example. We're selective about it."
And the study will not change the practice at Mount Sinai, which is governed by the rules of the New York Organ Donor Network, Bromberg said. "The overwhelming majority of kidneys transplanted in New York have been on the machine," he said. "Every now and then, we don't use it."
Still, the study does not provide definitive evidence about whether perfusion is necessary for all donated kidneys, Bromberg said.
The practice in New England is to use perfusion for "extended-criteria" kidneys, such as those from older donors or donors whose heart stopped beating before the kidney was removed, said Dr. Stefan G. Tullius, chief of transplant surgery at Brigham and Women's Hospital in Boston, who wrote an editorial accompanying the journal report.
"We will continue to do that," Tullius said. "But there will be greater emphasis on using perfusion with the report of this clinical trial."
The study showed "a significant reduction of delayed organ function, which is certainly a very unique finding, and this is the first trial showing it," Tullius said.
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