Normothermic machine perfusion applications in kidney transplantation.

PURPOSE OF REVIEW: Normothermic machine perfusion (NMP) has emerged as technology for organ preservation and assessment. While NMP has been widely adopted for liver, lung, and heart transplantation, kidney NMP has faced slower clinical integration. Normothermic perfusion may potentially improve kidney transplant through improved preservation, graft viability assessment, mitigation of ischemia reperfusion injury, and treatment prior to transplant. The purpose of this review is to highlight the applications of NMP in kidney transplantation.

RECENT FINDINGS: Kidney NMP has been proven well tolerated and feasible in multiple studies. Two recent randomized controlled trials did not demonstrate a benefit of NMP compared to cold storage. The use of NMP may increase utilization through improved logistics. Graft assessment during perfusion may allow for well tolerated transplantation of marginal kidneys. Successful long-term perfusion up to 4 days of discarded kidneys has been performed. Gene therapies and treatments, including immune modification, have been carried out during kidney NMP.

SUMMARY: Normothermic perfusion has several applications to kidney transplantation including preservation, assessment, and treatment. Perfusion protocols viability criteria need to be defined. A portable, commercially available device is needed to increase clinical use. Further studies are needed to compare NMP to current preservation methods.