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Updated: Mar 2, 2026
Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
Ex vivo machine perfusion for renal graft preservation
J Moritz Kaths1, Andreas Paul2, Lisa A Robinson3
1Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany; Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Division of Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Abstract:
Kidney transplantation is the treatment of choice for end-stage renal disease. Despite its superiority over dialysis, the persisting organ shortage remains a major drawback. Additional sources to increase the donor pool are grafts recovered from extended criteria donors (ECD) and donation after circulatory death (DCD). Although transplantation of marginal grafts demonstrates promising outcomes, increased rates of primary non-function, delayed graft function, and reduced graft survival have been reported. Cold ischemic injury, caused by static cold storage is a significant risk factor for poor outcome. Machine perfusion (MP) at various temperatures bears the potential to improve organ preservation, assessment, and repair. While hypothermic machine perfusion (HMP) is well established in clinical practice, modified HMP, subnormothermic machine perfusion (SMP), and normothermic machine perfusion (NMP) are novel emerging strategies with the potential to significantly improve the outcome of marginal kidney grafts. This review summarizes findings and recent advances from pre-clinical and clinical machine perfusion studies, organized by temperature, and discusses potential future developments for graft assessment and repair.
