Abstract
Transportable normothermic kidney perfusion for 24 hours or longer could enable viability assessment of marginal grafts, increased organ use, and improved transplant logistics. Eleven clinically declined kidneys were perfused normothermically, with 6 being from donors after brain death (median cold ischemia time 33 ± 36.9 hours) and 5 being from donors after circulatory death (36.2 ± 38.3 hours). Three kidneys were perfused using Ringer’s lactate to replace excreted urine volume, and 8 kidneys were perfused using urine recirculation to maintain perfusate volume without fluid replenishment. In all cases, normothermic perfusion either maintained or slightly improved the histopathologically assessed tubular condition, and there was effective urine production in kidneys from both donors after brain death and donors after circulatory death (2367 ± 1798 mL vs 744.4 ± 198.4 mL, respectively; P = .44). Biomarkers, neutrophil gelatinase–associated lipocalin, and kidney injury molecule‐1 were successfully detected and quantified in the perfusate. All kidneys with urine recirculation were readily perfused for 24 hours (n = 8) and exhibited physiological perfusate sodium levels (140.7 ± 1.2 mmol/L), while kidneys without urine recirculation (n = 3) achieved a reduced normothermic perfusion time of 7.7 ± 1.5 hours and significantly higher perfusate sodium levels (159.6 ± 4.63 mmol/:, P < .01). Normothermic machine perfusion of human kidneys for 24 hours appears to be feasible, and urine recirculation was found to facilitate the maintenance of perfusate volume and homeostasis.
Highlights
As outcomes of kidney transplant have improved and the incidence of renal failure has increased, the indications and demand for transplant have expanded
There has been a resurgence of interest in hypothermic machine perfusion (HMP)
This is the first report of prolonged normothermic human kidney preservation and of the use of a closed perfusion circuit with urine recirculation
Summary
As outcomes of kidney transplant have improved and the incidence of renal failure has increased, the indications and demand for transplant have expanded. Reasons for termination of the kidney perfusions were (i) arterial flow ≤50 mL/min, (ii) pH 7.7 measured at a PCo2 level of 5, and/or (iii) sudden cessation of urine production. The concentrations of all biomarkers increased during 24 hours of NMP from the first time point to the last time point of measurement in the urine recirculation group This could be detected in all 9 analyzed kidneys (Table 5) and reflects a constant release of biomarkers into the perfusate during the process of normothermic preservation in a fully closed circuit with urine recirculation. The perfusate levels of both NGAL and KIM-1 decreased over time in the group without urine recirculation, kidneys 9-11.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
