Purpose of review
To summarise recently published studies of donor pretreatment
and machine perfusion
strategies in kidney transplantation.
The sparsity of donor pretreatment
trials has resulted in the re-analysis of already existing data, and RCTs are urgently needed to reinvigorate this aspect of donor research. Uncontrolled donation after circulatory death
kidney transplantation has the highest risk of delayed graft function and graft failure, and recent studies have reported that normothermic regional perfusion improves graft function and survival in this setting. Hypothermic machine perfusion
reduces delayed graft function following deceased donor kidney transplantation across donor types but unanswered questions still remain regarding its use. The use of oxygenated hypothermic machine perfusion
appears to improve graft function in controlled donation after circulatory death
mediated by a reduction in acute rejection. Ex-situ normothermic perfusion is emerging and while technically challenging it may facilitate the delivery of pretreatments.
RCTs are urgently needed to reinvigorate research into donor pretreatment
and to establish the place of specific preservation techniques in deceased donor kidney transplantation.