EXAM: Ex-vivo allograft monitoring dashboard for the analysis of hypothermic machine perfusion data in deceased-donor kidney transplantation

Deceased-donor kidney allografts are exposed to ischemic injury during ex vivo transport due to the lack of blood oxygen supply. Hypothermic machine perfusion (HMP) effectively reduces the risk of delayed graft function in kidney transplant recipients compared to standard cold storage. However, no free software implementation is available to analyze HMP data for state-of-the-art visualization and quality control. We developed the tool EXAM (ex-vivo allograft monitoring) as an interactive analytics dashboard. We wrote functions in the R programming language to read, process, and analyze HMP data from the LifePort kidney transporter (Organ Recovery Systems, USA). Time series for pressure, flow rate, organ resistance, and temperature are visualized, and relevant statistical indicators have been developed. We explain how data were processed, and indicators were calculated, and we present summary statistics for N = 255 kidney allografts receiving machine perfusion in Switzerland between 2020 and 2023. Median (interdecile range, IDR) of the main indicators were as follows: perfusion duration 5.18 hours (2.29−11.2), flow rate 110 ml/min (52.9−167), ice temperature 1.97°C (1.53−3.07), and perfusate temperature 6.68°C (5.58−8.36). We implemented the dashboard to identify issues, such as atypical perfusion parameters, high ice, or high perfusate temperature to inform transplant centers for quality assurance. In conclusion, EXAM is a free tool that statisticians and data scientists can quickly deploy to enable quality control at transplant organizations that use LifePort kidney transporters. An online viewer is available at https://data.swisstransplant.org/exam/.Author summary: In deceased-donor kidney transplantation, a widely used treatment is to perfuse the kidney with a cold preservation solution during transport (hypothermic machine perfusion). High-quality evidence shows that this intervention reduces the risk of delayed graft function in the recipient after transplantation. There are only a few devices available, among them the LifePort kidney transporter, which records the time series of the perfusion and temperature parameters (vascular resistance, flow rate, ice, and perfusate temperature). Currently, no software exists to read, process, visualize, and perform statistics with LifePort data. We created EXAM (ex-vivo allograft monitoring), a free tool that provides an online state-of-the-art analytics dashboard. Our work will enable transplant organizations to inspect their data, perform statistics and quality checks to help identify potential problems and optimize the intervention to the benefit of kidney recipients.