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Related Concept Videos

Kidney Transplant I: Introduction01:28

Kidney Transplant I: Introduction

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A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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Kidney Transplant II: Surgical Procedure01:26

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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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Updated: Jan 7, 2026

Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
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Optimizing Prolonged (6 h) Normothermic Machine Perfusion of Donor Kidneys (PROPER Study).

Asel S Arykbaeva1,2, Veerle A Lantinga3, L Leonie van Leeuwen3,4

  • 1Department of Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands.

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Summary

Extending kidney preservation using normothermic machine perfusion (NMP) to six hours is feasible. This extended NMP protocol, incorporating improved perfusate and graft monitoring, maintained kidney viability and histological stability for transplantation.

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Area of Science:

  • Nephrology
  • Transplantation immunology
  • Organ preservation

Background:

  • Ex situ normothermic machine perfusion (NMP) is a promising technique for kidney graft preservation and viability assessment.
  • Current NMP protocols are typically limited to 1-2 hours, with no adverse impact on early graft function.
  • Prolonging NMP offers extended evaluation and therapeutic intervention windows before transplantation.

Purpose of the Study:

  • To assess the feasibility of extending normothermic machine perfusion (NMP) duration for donor kidneys up to 6 hours.
  • To investigate the necessary modifications for safe and effective prolonged NMP.

Main Methods:

  • Human donor kidneys unsuitable for transplantation were used for experimental NMP.
  • Perfusion duration was extended to 6 hours.
  • Graft viability was assessed through metabolic activity, biochemical and histological injury analysis, and perfusate/urine analysis.

Main Results:

  • Improvements in erythrocyte quality, oncotic pressure, and electrolyte balance were crucial for stable perfusion.
  • Extended 6-hour NMP demonstrated preserved renal viability and stable histological characteristics.
  • The protocol modifications facilitated steady flow volumes and favorable graft appearance.

Conclusions:

  • Prolonging normothermic machine perfusion (NMP) of donor kidneys to 6 hours is feasible with the implemented protocol.
  • Key elements include using fresh washed red blood cells, adding albumin, and urine recirculation for stable perfusion.
  • Further refinements are needed for widespread clinical application of prolonged NMP.