Prolonged Normothermic Ex Vivo Kidney Perfusion Is Superior to Cold Nonoxygenated and Oxygenated Machine Perfusion for the Preservation of DCD Porcine Kidney Grafts

Laura I Mazilescu, Peter Urbanellis, Moritz J Kaths, Sujani Ganesh, Toru Goto, Yuki Noguchi, Rohan John, Ana Konvalinka, Istvan Mucsi, Anand Ghanekar, Darius J Bagli, Julie Turgeon, Annie Karakeusian Rimbaud, Marie-Josée Hébert, Mélanie Dieudé, Isabelle Alleys, Etienne Dore, Eric Boilard, Herman S Overkleeft, Lianne I WillemsLisa A Robinson, Markus Selzner

Research output: Contribution to journalArticlepeer-review


The increased usage of marginal grafts has triggered interest in perfused kidney preservation to minimize graft injury. We used a donation after circulatory death (DCD) porcine kidney autotransplantation model to compare 3 of the most frequently used ex vivo kidney perfusion techniques: nonoxygenated hypothermic machine perfusion (non-oxHMP), oxygenated hypothermic machine perfusion (oxHMP), and normothermic ex vivo kidney perfusion (NEVKP).

Methods: Following 30 min of warm ischemia, grafts were retrieved and preserved with either 16 h of non-oxHMP, oxHMP, or NEVKP (n = 5 per group). After contralateral nephrectomy, grafts were autotransplanted and animals were followed for 8 d. Kidney function and injury markers were compared between groups.

Results: NEVKP demonstrated a significant reduction in preservation injury compared with either cold preservation method. Grafts preserved by NEVKP showed superior function with lower peak serum creatinine (NEVKP versus non-oxHMP versus oxHMP: 3.66 ± 1.33 mg/dL, 8.82 ± 3.17 mg/dL, and 9.02 ± 5.5 mg/dL) and more rapid recovery. The NEVKP group demonstrated significantly increased creatinine clearance on postoperative day 3 compared with the cold perfused groups. Tubular injury scores on postoperative day 8 were similar in all groups.

Conclusions: Addition of oxygen during HMP did not reduce preservation injury of DCD kidney grafts. Grafts preserved with prolonged NEVKP demonstrated superior initial graft function compared with grafts preserved with non-oxHMP or oxHMP in a model of pig DCD kidney transplantation.

Original languageEnglish
Article numbere751
JournalTransplantation direct
Issue number10
Publication statusPublished - 7 Sept 2021

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Copyright © 2021 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.

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