Moers 2009

Methods	Study design: parallel RCT Duration of study: 1 November 2005 to 31 October 2006 Duration of follow‐up: 36 months
Participants	Country: Netherlands, Belgium and Germany Setting: multinational Donor characteristics Mean age (range): 51 years (16 to 81) Number of DCD: 82 (164 kidneys) Number of ECD: 94 (188 kidneys) Sex (M/F): not reported Inclusion criteria: organ donors had to be 16 years of age or older. Only kidney pairs from deceased donors were included in the study, either from donation after brain death or donation after CCD. The category for donors without a heartbeat had to be Maastricht category III (awaiting CCD after withdrawal of treatment) or IV (CCD in a brain‐dead donor). Exclusion criteria: Kidney pairs were excluded if both organs were not transplanted into two different recipients. If one kidney was transplanted into the same recipient together with another organ, this kidney pair was excluded Recipient characteristics Inclusion criteria: recipient of a single kidney Exclusion criteria: only exclusion criterion for recipients was the death of the patient in the first week after transplantation, since a follow‐up of at least 1 week was required to determine the primary end point Sex (M/F): not reported Mean age, range (years): MP group (52, 2 to 79); SCS group (53, 11 to 79)
Interventions	Machine perfusion LifePort transporter machines (pulsatile perfusion) using KPS‐1 solution Static cold storage UW or HTK solutions Mean CIT Mean time was 15 hours, and did not differ significantly between the groups
Outcomes	DGF Duration of DGF PNF SCr Creatinine clearance at day 14 Acute rejection Length of hospital stay One‐year patient survival One‐year graft survival Three‐year patient survival Three‐year graft survival
Notes	672 kidneys from 336 donors (plus a further 80 kidneys from 40 donors which were detailed in the 2010 report by Jochman et al.) One kidney from each pair assigned to MP and the other to SCS Many papers were published based on the original 2009 Moers study, including in depth analysis of various subgroups. Some of these reports acted as useful sources for subgroup analysis, and could be included in the meta‐analysis. A letter submitted to the New England Journal of Medicine in 2012 reported 3‐year patient and graft survival The research was "supported by organ recovery systems".
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomisation lists for each study region
Allocation concealment (selection bias)	Low risk	Allocation happened prior to procurement, whilst the donor was still in the ICU
Blinding of participants and personnel (performance bias) All outcomes	Low risk	They performed blinding at the time of organ offer, so a centre could not turn down a kidney on the basis of storage method
Blinding of outcome assessment (detection bias) All outcomes	Low risk	No blinding, but outcome measurements are unlikely to be affected by the lack of blinding
Incomplete outcome data (attrition bias) All outcomes	Low risk	Only 1 patient out of 672 was lost to follow‐up. The rest were followed up to at least one year
Selective reporting (reporting bias)	Low risk	All outcomes reported were present in the original study protocol except for PNF
Other bias	Unclear risk	Intention to treat analysis likely not completed