Revolutionizing Renal Replacement: Current Advancements in Development and Transplantation of Bioengineered Kidneys

Area of Science:

• Biomedical Engineering
• Regenerative Medicine
• Nephrology

Background:

• Chronic kidney disease (CKD) is a growing global health concern.
• Current renal replacement therapies face significant challenges, including organ scarcity and complications.
• Innovative treatments are urgently needed to address the limitations of transplantation and dialysis.

Purpose of the Study:

• To review the feasibility of bioengineered kidneys as an alternative to current renal replacement therapies.
• To discuss advancements in decellularization, recellularization, and cell-on-scaffold kidney transplantation.
• To outline a hierarchical, staged process for developing functional bioengineered kidneys.

Main Methods:

• Narrative review of current research on bioengineered kidneys.
• Assessment of decellularization techniques for creating kidney scaffolds.
• Evaluation of recellularization strategies and transplantation outcomes.
• Discussion of emerging techniques like 3D bioprinting.

Main Results:

• Perfusion-based decellularization effectively produces acellular human kidney scaffolds preserving extracellular matrix.
• Partial recellularization of kidney scaffolds has demonstrated urine production and filtration in large animals.
• Complete endothelialization of the vascular network is critical to prevent post-transplant thrombosis.
• Whole-organ recellularization remains a significant challenge, with most studies being proof-of-concept.

Conclusions:

• Bioengineered kidneys represent a promising avenue for clinical application, despite current limitations.
• Vascular patency is the primary prerequisite for graft survival, followed by glomerular filtration and then tubular function.
• Further research with larger trials is recommended to validate findings and overcome challenges in whole-organ regeneration.