The use of a centralized normothermic preservation and assessment center to rescue kidneys declined after standard allocation.

Normothermic machine perfusion (NMP) may increase utilization of nonideal donor kidneys through improved preservation and assessment. We assessed the use of a centralized perfusion service to rescue declining kidneys for transplant. Kidneys that exhausted the standard Organ Procurement and Transplantation Network allocation underwent 2 hours of NMP for additional assessment. The primary outcome was rescue for transplantation. Outcomes of NMP kidneys were compared with those of non-NMP kidneys transplanted during the study period at the same transplant centers. NMP was performed on 104 declined kidneys, and 94 (90%) were rescued for transplant. NMP donors were older, with a higher kidney donor profile index score compared with non-NMP donors. Cold ischemia time was significantly longer in the NMP cohort (median, 37.6 vs 22.1 hours; P < .001). The weighted percentage of delayed graft function was 26.3% in the NMP group vs 60.2% in the non-NMP group (P = .023). Overall graft survival was similar between the groups. With the use of a centralized NMP service, kidneys that declined based on standard clinical parameters may be evaluated, rescued, and successfully transplanted. Kidneys undergoing NMP experienced significantly lower rates of delayed graft function compared with non-NMP kidneys. Additional follow-up is needed to determine the effects of NMP on long-term graft function.