Normothermic Machine Perfusion and Inflammatory Mediators Adsorption: First Kidney Transplant Experience.

Area of Science:

• Transplantation immunology
• Organ preservation technologies
• Regenerative medicine

Background:

• Organ shortages necessitate using extended criteria donor (ECD) organs for kidney transplantation.
• Ischemia-reperfusion injury (IRI) is a major cause of long-term graft dysfunction, particularly with ECD kidneys.
• Ex-situ organ perfusion, including normothermic machine perfusion (NMP), offers a platform to mitigate IRI and assess organ viability.

Purpose of the Study:

• To evaluate the efficacy of integrating an inflammatory mediators' removal (IMR) device into NMP for recovering an ECD kidney.
• To assess the impact of IMR-NMP on organ viability markers and inflammatory cytokine profiles.
• To determine the post-transplantation outcomes of an ECD kidney treated with IMR-NMP.

Main Methods:

• An ECD kidney was subjected to 320 minutes of normothermic machine perfusion (NMP).
• An integrated inflammatory mediators' removal (IMR) device was employed to adsorb inflammatory molecules during perfusion.
• Organ viability was assessed through urine output, and inflammatory cytokine levels were monitored.
• Post-transplantation outcomes, including delayed graft function (DGF), were evaluated.

Main Results:

• The IMR device effectively removed inflammatory cytokines in a concentration-dependent manner during NMP.
• The perfused ECD kidney exhibited significant urine output, indicating preserved viability.
• The transplanted kidney showed successful outcomes with no instances of delayed graft function (DGF).
• The perfusion process allowed for detailed organ viability assessments and cytokine modulation.

Conclusions:

• Integrating an IMR device with NMP is a promising strategy for recovering ECD kidneys prior to transplantation.
• This approach effectively modulates inflammatory responses and preserves organ viability, mitigating IRI.
• The successful clinical outcome suggests potential for improved graft survival and function in kidney transplantation using this method.
• Further research is warranted to investigate the long-term clinical impact on graft survival.