Machine Perfusion as a Temporal and Resuscitative Bridge in Emergent Renal Autotransplantation: A Novel Case Report

BACKGROUND Renal autotransplantation is a well-described but infrequently used alternative to nephrectomy, complex renal or ureteral reconstruction, and allograft transplantation. While commonly performed and reported in the elective setting, it can be limited by ischemia, hemodynamic stability, and operative timing. Its use in the emergent setting can be limited by the patient's clinical stability and by the inability to safely perform immediate reimplantation. Hypothermic machine perfusion has been well described as a tool to improve outcomes following deceased donor transplantation. However, the role of hypothermic machine perfusion in autologous transplantation has not been clearly defined. CASE REPORT We describe a novel case of emergent renal explantation in a 56-year-old woman followed by delayed autotransplantation after a period of hypothermic machine perfusion. Reimplantation was performed following resuscitation and stabilization of the patient. After a period of postoperative delayed graft function, the patient experienced recovery of her native renal function and was ultimately able to discontinue hemodialysis. CONCLUSIONS This case demonstrates the safety and viability of renal autotransplantation following preservation with hypothermic machine perfusion. Machine perfusion can function as a temporal bridge in emergent situations when immediate reimplantation is unsafe, expanding the indications for organ preservation beyond deceased donation. This approach enables staged reconstruction in patients who may otherwise not be appropriate transplant candidates.