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Updated: May 12, 2026
Ex Situ Normothermic Machine Perfusion of Donor Livers
Published on: May 26, 2015
Limited Risk of Microbial Contamination During Hypothermic and Normothermic Machine Perfusion of Donor Kidneys
Julia S Slagter1, Carolina A M Schurink2,3, Ga-Lai M Chong2
1Department of Surgery, Erasmus MC Transplant Institute, Division of HPB and Transplant Surgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands.
Background:
Both hypothermic machine perfusion (HMP) and normothermic machine perfusion (NMP) are increasingly used for preservation of deceased donor kidneys. However, especially NMP can pose as a risk for microbial contamination of the kidney graft as the 37°C perfusate can act as a breeding ground for microbial contaminants.
Methods:
In this study, we investigated the cultures of HMP and NMP perfusates of deceased donor kidneys.
Results:
Between January 2021 and April 2024, a total of 99 perfusates were examined (73 HMP and 26 NMP perfusates)-. We found that contamination of HMP perfusate was common, occurring in 21 of 73 cultures (29%). Most bacteria originated from the skin. Microbial contamination during NMP was rare, occurring only in 2 of 26 cultures (8%). Microbial contamination during machine perfusion did not lead to infectious complications in the recipients.
Conclusion:
Machine perfusion poses a very limited risk of infection in kidney transplant recipients.
Insights
Microbial contamination during kidney preservation is a concern, especially with normothermic machine perfusion (NMP). However, this study found machine perfusion poses a very limited risk of infection in kidney transplant recipients.
Area of Science:
- Nephrology
- Transplantation immunology
- Microbiology
Background:
- Hypothermic machine perfusion (HMP) and normothermic machine perfusion (NMP) are common methods for preserving deceased donor kidneys.
- Normothermic machine perfusion (NMP) at 37°C may increase the risk of microbial contamination in kidney grafts.
Purpose of the Study:
- To investigate the incidence and sources of microbial contamination in HMP and NMP perfusates.
- To assess the risk of infectious complications in kidney transplant recipients following machine perfusion.
Main Methods:
- Analysis of perfusate cultures from 99 deceased donor kidney preservation cases (73 HMP, 26 NMP) between January 2021 and April 2024.
- Identification of microbial contaminants and correlation with clinical outcomes.
Main Results:
- Contamination was observed in 29% of HMP perfusates, primarily from skin bacteria.
- Microbial contamination was rare in NMP perfusates, occurring in only 8% of cases.
- No infectious complications were reported in recipients despite detected microbial contamination.
Conclusions:
- Machine perfusion of donor kidneys is associated with a low risk of infectious complications in recipients.
- The findings suggest that current machine perfusion protocols are safe for kidney transplantation.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure