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Ex-vivo machine perfusion for kidney preservation

Hamar, Matyas; Selzner, Markus

Current Opinion in Organ Transplantation: June 2018 - Volume 23 - Issue 3 - p 369–374
doi: 10.1097/MOT.0000000000000524

Purpose of review Machine perfusion is a novel strategy to decrease preservation injury, improve graft assessment, and increase organ acceptance for transplantation. This review summarizes the current advances in ex-vivo machine-based kidney preservation technologies over the last year.

Recent findings Ex-vivo perfusion technologies, such as hypothermic and normothermic machine perfusion and controlled oxygenated rewarming, have gained high interest in the field of organ preservation. Keeping kidney grafts functionally and metabolically active during the preservation period offers a unique chance for viability assessment, reconditioning, and organ repair. Normothermic ex-vivo kidney perfusion has been recently translated into clinical practice. Preclinical results suggest that prolonged warm perfusion appears superior than a brief end-ischemic reconditioning in terms of renal function and injury. An established standardized protocol for continuous warm perfusion is still not available for human grafts.

Summary Ex-vivo machine perfusion represents a superior organ preservation method over static cold storage. There is still an urgent need for the optimization of the perfusion fluid and machine technology and to identify the optimal indication in kidney transplantation. Recent research is focusing on graft assessment and therapeutic strategies.

Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Ontario, Canada

Correspondence to Markus Selzner, MD, Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, 11 PMB 178, 585 University Avenue, Toronto, ON M5G 2N2, Canada. Tel: +1 416 340 4800 x5884; fax: +1 416 340 5321; e-mail:

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