Subnormothermic Oxygenated Machine Perfusion (24 h) in DCD Kidney Transplantation

Area of Science:

• Organ transplantation and preservation
• Nephrology
• Surgical innovation

Background:

• Ex vivo kidney perfusion is promising but lacks consensus on optimal conditions.
• Hypothermic perfusion limits functional assessment; normothermic perfusion is complex.
• Subnormothermic machine perfusion (SNMP) offers a potential balance but needs more investigation.

Purpose of the Study:

• To determine the suitability of SNMP for extended kidney preservation.
• To assess SNMP's effectiveness in maintaining kidney graft function.
• To compare SNMP with static cold storage (SCS) for donation after circulatory death (DCD) kidneys.

Main Methods:

• SNMP at 22-25 °C was used for 24-hour perfusion of porcine kidneys.
• Graft assessment included mechanical and biochemical parameters.
• Porcine kidney autotransplants in a DCD model and human kidney perfusion were performed.

Main Results:

• SNMP ensured stable perfusion and graft function in porcine kidneys for 24 hours.
• SNMP-preserved DCD grafts showed superior posttransplant function compared to SCS.
• Human kidneys perfused with SNMP demonstrated stable functional and biological parameters.

Conclusions:

• SNMP is suitable for stable kidney perfusion and shows cross-species generalizability.
• SNMP provides foundational evidence for improved DCD kidney transplant outcomes compared to SCS.