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Updated: Jul 9, 2026
Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
Published on: July 15, 2015
Quality Assessment of Discarded Human Kidneys Using Normothermic Perfusion
Enrique Montagud-Marrahi1,2,3, Thomas Prudhomme4,5, Tarek Ajami5,6
1Kidney Transplant Unit, Nephrology and Kidney Transplantation Department, Hospital Clinic of Barcelona, Spain.
Background:
Ex vivo normothermic perfusion (EVNP) allows for comprehensive functional assessment; however, current scoring systems are validated only for short perfusion durations. This study investigates the utility of the EVNP quality assessment score for a 6-h period to predict viability in discarded human kidneys.
Methods:
Twenty human kidneys from marginal donors, previously declined for transplantation, underwent 6-h EVNP. Functional parameters (renal blood flow, resistance index, urine output), perfusate biochemistry, tissue injury biomarkers, and histology were assessed. Kidneys were stratified by EVNP score: group A (1-2), group B (3), and group C (4-5).
Results:
Group A demonstrated significantly higher renal blood flow (median 213.5 versus 145.1 [B] versus 81.7 mL/min [C], P < 0.0001), lower resistance index (0.32 versus 0.41 [B] versus 0.86 mL/min/mm Hg [C], P < 0.0001), greater urine output (241.1 versus 97.9 [B] versus 10.9 mL [C], P < 0.0001), and more favorable perfusate profiles (lactate: 14.2 versus 15.7 [B] versus 19.9 mg/dL [C], P = 0.02). Histological scores did not correlate with EVNP score groups at baseline or after perfusion. EVNP during 6 h showed trends consistent with functional graft performance, suggesting it may help inform decisions to reduce organ discard.
Conclusions:
The EVNP score may assist in identifying kidneys with potential for transplantation despite suboptimal histology, which could contribute to reducing the underutilization of marginal grafts.
