ORIGINAL RESEARCH
Transpl. Int.
Nationwide Hypothermic Machine Perfusion for ECD and DCD Kidney Transplantation in Belgium: One-Year Outcomes and impact on Transplant Rates and budget impact analysis
Tom Darius 1
Ina Jochmans 2
Maxime Foguenne 1
Eric Hoste 3
Caren Randon 4
Bart Bracke 5
Geert Roeyen 5
Nicholas Gilbo 6
Laurent Weekers 7
Daniel Jacobs-Tulleneers-Thevissen 8
Karl Martin Wissing 9
Tineke Bogaerts 8
Dimitri Mikhalski 10
jean-Philippe De Wilde 11
Joël Daems 12
Jacques Pirenne 2
1. Department of Surgery, Surgery and Abdominal Transplant Unit, Cliniques universitaires Saint-Luc, Brussels, Belgium
2. Department of Surgery, Abdominal Transplant Surgery, UZ Leuven, Leuven, Belgium
3. Department of Intensive Care Medicine, Universitair Ziekenhuis Gent, Ghent, Belgium
4. Department of Thoracic and Vascular Surgery, Universitair Ziekenhuis Gent, Ghent, Belgium
5. Department of Hepatobiliary, Endocrine, and Transplantation Surgery, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
6. Division of Abdominal Surgery and Transplantation, CHU de Liege, Liège, Belgium
7. Division of Nephrology, CHU de Liege, Liège, Belgium
8. Department of Surgical Oncology, Thoracic Surgery and Transplantation, Universitair Ziekenhuis Brussel, Brussels, Belgium
9. Nephrology department, Universitair Ziekenhuis Brussel, Brussels, Belgium
10. Department of Abdominal Surgery and Transplantation, Hopital Erasme, Brussels, Belgium
11. Department of Vascular Diseases, Hopital Erasme, Brussels, Belgium
12. Rijksinstituut voor Ziekte- en Invaliditeitsverzekering, Brussels, Belgium
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Abstract
In September 2022, Belgium implemented a nationally reimbursed HMP service for all ECD and DCD kidneys procured and transplanted within the country. We retrospectively analyzed data from 242 kidney transplantations preserved with continuous HMP between October 2022 and September 2023. Active oxygenation (HMPO₂) was applied in DCD⩾50years. One-year outcomes for all HMP kidneys included delayed graft function (DGF) in 14.4%, estimated glomerular filtration rate of 50 ml/min/1.73m², 10.1% acute rejection, 96.3% death-censored graft survival, and 98.3% patient survival. DGF rates were lower in ECD kidneys (9.1%) and in DCD ≤50 years (9.5%), while higher in DCD >50 years (19.6%). National transplantation rates of DCD kidneys significantly increased from 90 to 175 per year (p<0.0001), but not for ECD kidneys (from 45 to 54 per year (p=0.2965) post-HMP implementation without affecting kidney export. The annual cost savings from reduced dialysis requirements were estimated at €3.59 million. The national implementation of a centralized HMP service in Belgium led to excellent one-year transplant outcomes, increased utilization of ECD and DCD kidneys, and substantial healthcare cost savings. These findings support HMP, and where appropriate HMPO₂, as the new standard of care for kidney preservation in Belgium, with potential implications for broader international collaboration.
Summary
Keywords
Hypothermic machine perfusion, kidney transplantation (KT), Hypothermic oxygenated machine perfusion, national implementation, Budget Impact Analysis
Received
17 July 2025
Accepted
23 October 2025
Copyright
© 2025 Darius, Jochmans, Foguenne, Hoste, Randon, Bracke, Roeyen, Gilbo, Weekers, Jacobs-Tulleneers-Thevissen, Wissing, Bogaerts, Mikhalski, De Wilde, Daems and Pirenne. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Tom Darius, tom.darius@saintluc.uclouvain.be
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