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Updated: Jan 2, 2026
Ex Situ Normothermic Machine Perfusion of Donor Livers
Published on: May 26, 2015
Donor pretreatment and machine perfusion: current views
Stephen O'Neill1, Gabriel C Oniscu1,2
1Edinburgh Transplant Centre, Royal Infirmary of Edinburgh.
Purpose Of Review:
To summarise recently published studies of donor pretreatment and machine perfusion strategies in kidney transplantation.
Recent Findings:
The sparsity of donor pretreatment trials has resulted in the re-analysis of already existing data, and RCTs are urgently needed to reinvigorate this aspect of donor research. Uncontrolled donation after circulatory death kidney transplantation has the highest risk of delayed graft function and graft failure, and recent studies have reported that normothermic regional perfusion improves graft function and survival in this setting. Hypothermic machine perfusion reduces delayed graft function following deceased donor kidney transplantation across donor types but unanswered questions still remain regarding its use. The use of oxygenated hypothermic machine perfusion appears to improve graft function in controlled donation after circulatory death mediated by a reduction in acute rejection. Ex-situ normothermic perfusion is emerging and while technically challenging it may facilitate the delivery of pretreatments.
Summary:
RCTs are urgently needed to reinvigorate research into donor pretreatment and to establish the place of specific preservation techniques in deceased donor kidney transplantation.
Insights
Research on donor pretreatment and machine perfusion in kidney transplantation is needed. Normothermic regional perfusion shows promise for donation after circulatory death, while hypothermic machine perfusion benefits deceased donor transplants.
Area of Science:
- Nephrology
- Transplantation immunology
- Surgical innovation
Background:
- Kidney transplantation outcomes are significantly impacted by donor management and organ preservation techniques.
- Donation after circulatory death (DCD) kidney transplantation presents unique challenges, including higher risks of delayed graft function (DGF) and graft failure.
- Established deceased donor kidney transplantation protocols require ongoing refinement to optimize graft survival.
Purpose of the Study:
- To review recent advancements in donor pretreatment strategies for kidney transplantation.
- To summarize the current evidence on machine perfusion techniques in kidney preservation.
- To identify research gaps and future directions in donor optimization and organ perfusion.
Main Methods:
- Systematic review of recently published studies on donor pretreatment and machine perfusion.
- Analysis of clinical trial data and observational studies.
- Synthesis of findings related to graft function, delayed graft function, and graft survival.
Main Results:
- Normothermic regional perfusion (NRP) demonstrates improved graft function and survival in uncontrolled DCD kidney transplantation.
- Hypothermic machine perfusion (HMP) effectively reduces DGF in deceased donor kidney transplantation across various donor types.
- Oxygenated HMP shows potential in mitigating acute rejection in controlled DCD kidney transplantation.
- Ex-situ normothermic perfusion is an emerging technique with potential for facilitating donor pretreatment delivery.
Conclusions:
- Randomized controlled trials (RCTs) are crucial to advance donor pretreatment research and define the role of specific preservation techniques.
- NRP is a promising strategy for high-risk DCD kidney allografts.
- Further research is needed to optimize HMP protocols and explore novel perfusion techniques for enhanced kidney allograft outcomes.
