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Updated: Jul 2, 2026
Ex Situ Normothermic Machine Perfusion of Donor Livers
Published on: May 26, 2015
Normothermic Machine Perfusion and Normothermic Regional Perfusion of DCD Kidneys Before Transplantation: A
Rowan Klein Nulend1, Ahmer Hameed1,2, Animesh Singla3
1Department of Surgery, Westmead Hospital, Westmead, NSW, Australia.
Background:
To overcome organ shortages, donation after circulatory death (DCD) kidneys are being increasingly used for transplantation. Prior research suggests that DCD kidneys have inferior outcomes compared with kidneys donated after brain death. Normothermic machine perfusion (NMP) and normothermic regional perfusion (NRP) may enhance the preservation of DCD kidneys and improve transplant outcomes. This study aimed to review the evidence surrounding NMP and NRP in DCD kidney transplantation.
Methods:
Two independent reviewers conducted searches for all publications reporting outcomes for NMP and NRP-controlled DCD kidneys, focusing on delayed graft function, primary nonfunction, graft function, graft survival, and graft utilization. Weighted means were calculated for all relevant outcomes and controls. Formal meta-analyses could not be conducted because of significant heterogeneity.
Results:
Twenty studies were included for review (6 NMP studies and 14 NRP studies). Delayed graft function rates seemed to be lower for NRP kidneys (24.6%) compared with NMP kidneys (54.3%). Both modalities yielded similar outcomes with respect to primary nonfunction (NMP 3.3% and NRP 5.6%), graft function (12-mo creatinine 149.3 μmol/L for NMP and 129.9 μmol/L for NRP), and graft utilization (NMP 83.3% and NRP 89%). Although no direct comparisons exist, our evidence suggests that both modalities have good short- and medium-term graft outcomes and high graft survival rates.
Conclusions:
Current literature demonstrates that both NMP and NRP are feasible strategies that may increase donor organ utilization while maintaining acceptable transplant outcomes and likely improved outcomes compared with cold-stored DCD kidneys. Further research is needed to directly compare NRP and NMP outcomes.
Insights
Normothermic machine perfusion (NMP) and normothermic regional perfusion (NRP) show promise for improving outcomes in donation after circulatory death (DCD) kidney transplants, offering viable alternatives to traditional cold storage and increasing organ utilization.
Area of Science:
- Nephrology
- Transplantation
- Organ Preservation
Background:
- Donation after circulatory death (DCD) kidneys are increasingly utilized to address organ shortages.
- DCD kidneys historically have inferior transplant outcomes compared to donation after brain death kidneys.
- Normothermic machine perfusion (NMP) and normothermic regional perfusion (NRP) are emerging preservation techniques for DCD kidneys.
Purpose of the Study:
- To review existing evidence on the efficacy of NMP and NRP in DCD kidney transplantation.
- To compare outcomes associated with NMP and NRP preservation methods.
- To assess the potential of NMP and NRP to improve DCD kidney transplant success rates.
Main Methods:
- Systematic literature search for studies on NMP and NRP in DCD kidney transplantation.
- Inclusion of 20 studies (6 NMP, 14 NRP) reporting on key transplant outcomes.
- Calculation of weighted means for outcomes due to heterogeneity precluding formal meta-analysis.
Main Results:
- Normothermic regional perfusion (NRP) showed lower delayed graft function rates (24.6%) compared to normothermic machine perfusion (NMP) (54.3%).
- Both NMP and NRP demonstrated comparable outcomes in primary nonfunction, 12-month creatinine levels, and graft utilization.
- Short- and medium-term graft outcomes and survival rates were favorable for both NMP and NRP preserved DCD kidneys.
Conclusions:
- NMP and NRP are feasible preservation strategies for DCD kidneys, potentially increasing organ utilization.
- Both techniques offer acceptable transplant outcomes, likely superior to traditional cold storage for DCD kidneys.
- Further research is warranted to directly compare the outcomes of NRP and NMP.
