Machine Perfusion Preservation for Kidney Transplantation

  • Naoto Matsuno


The large gap between organ supply and demand emphasizes the importance of using all available donor sources. The shortage of donors for kidney transplantation is a universal problem. The waiting list has continued to grow, and the discrepancy between demand and supply is still increasing. The use of marginal donors is a promising way to increase the supply. In particular, the use of organs from non-heart-beating donors (NHBD) or donation after cardiac death (DCD) is acquiring increasing importance as a potential source of vital organs for clinical transplantation. However, with these expanded donor criteria (ECD), difficulties have been experienced because of preexisting organ damage from hypotension, which is associated with poor perfusion of kidney grafts. Unlike the recipients with heart beating donor kidneys, recipients of NHBD organs experience a higher incidence of primary nonfunction (PNF) and delayed graft function requiring postoperative hemodialysis (HD), prolonged hospitalization, and difficulties in the diagnosis of acute rejection. Long-term graft function and survival might be adversely affected by a delayed function of the kidneys after transplantation [1, 2]. The two approaches to preservation prior to transplantation are simple cold storage (SCS) and machine perfusion (MP). The simplicity, lower cost, and need for transport make cold storage the method of choice for the majority of renal transplant centers. However, continuous machine perfusion supplies or helps regenerate metabolic substances lost during warm ischemia and maintain near physiological conditions. It also maintains the intracellular pH and discharges waste, dilutes or neutralizes catabolic substances, and reduces sodium-dependent tissue edema (Fig. 15.1) [3, 4]. The histological integrity may be related to improved perfusion of the renal cortex microcirculation with the removal of red cells. These metabolic and physiological benefits lead to a reduction in the need for post-transplant dialysis by lowering the incidence of post-transplant acute tubular necrosis, resulting in a shorter hospital stay and better long-term survival. Another advantage of MP is the ability to perform viability testing. The perfusate chemistry, changes in the flow, and resistance during machine perfusion can be synchronously measured as a pretransplant viability test (Table 15.1). Within the marginal kidney donor pools, hypothermic machine perfusion (HMP) may be of major importance, because it can expand the utilization of ECD and DCD kidneys.


Cold Storage Warm Ischemia Delay Graft Function Donation After Cardiac Death Machine Perfusion 
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Copyright information

© Springer Japan 2014

Authors and Affiliations

  1. 1.Division for Innovative Surgery and TransplantationNational Center for Child Health and DevelopmentTokyoJapan

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