Normothermic ex vivo perfusion of deceased donor kidneys and its clinical potential in kidney transplantation outcomes

Abstract

In recent years, normothermic machine perfusion (NMP) has emerged in conversation surrounding organ preservation and transplantation techniques with the goal of improving patient and clinical outcomes. This is in great attempt to address the rate of non-utilization and the shortage of available organs in kidney transplantation. This focus in mind, normothermic perfusion presents itself as a potential tool to mimic physiological conditions and improve current preservation methods, such as static cold storage. This review serves to improve understanding of the observed connection between the consequences of ischemia and reperfusion injury and traditional preservation techniques as well as how renal NMP may mitigate these issues. Previous studies suggest that reducing time in static cold storage methods by promoting the normothermic perfusion model results in decreased delayed graft function and post-transplant complications. This review also aims to present the immense clinical potential NMP has on future kidney transplantation success and what this means for the fields of nephrology and transplantation. While great strides have been made to evaluate normothermic perfusion’s impact on kidney graft viability and transplant success, future research into unified protocol, clinically relevant biomarkers, cost-utility analysis, and use with associated therapeutic and imaging modalities is paramount.

The Puzzle of Preimplantation Kidney Biopsy Decision-Making Process: The Pathologist Perspective

“…Different kinds of liquids are available nowadays as long as pulsatile systems and temperature-regulating machines keep the harvested organs in solutions closely resembling its physiological conditions. Some advantages of perfusion machines are: extended preservation time (this is essential for organs that need to be transported over longer distances or when there is a delay between organ retrieval and transplantation), improved organ viability (perfusion with a preservation solution helps to maintain optimal oxygenation and nutrient supply to the organ), organ evaluation/assessment (functional parameters can be monitored during perfusion), treatment of ischemia-reperfusion injury (allowing for interventions during the perfusion process to mitigate ischemia-reperfusion injury, enhancing the organ's post-transplant performance), and improving transplantation from marginal donors (improving the condition of these organs and making them more suitable for transplantation) [49][50][51]. In detail, compared to SCS, machine-perfused kidneys have revealed significantly lower rates of delayed graft function (DGF) and, overall, reduced transplant-related costs.…”