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Purpose of Review <p>Kidney machine perfusion has moved from a niche preservation tool to a central strategy for using higher-risk deceased donor kidneys. This narrative review examines how contemporary perfusion platforms are reshaping preservation, viability assessment and the emerging concept of organ rehabilitation in kidney transplantation.</p> Recent Findings <p>Continuous hypothermic machine perfusion now has the strongest clinical evidence and reduces delayed graft function in selected deceased-donor grafts. Oxygenated hypothermic perfusion and controlled oxygenated rewarming show increasingly supportive mechanistic and clinical signals, particularly in kidneys at greater ischaemic risk. Normothermic machine perfusion offers direct functional assessment and a platform for ex situ therapy, but the benefits of outcome remain less settled than early enthusiasm suggested. Across platforms, composite assessment models appear more defensible than single perfusion markers.</p> Summary <p>Ex situ perfusion is no longer simply a method of storage. It is becoming a platform for preservation, assessment, rescue of declining kidneys and targeted biological intervention. The next phase of the field will depend on standardised trial design, validated composite viability tools and service models that improve both organ utilisation and post-transplant outcomes.</p>

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Machine Perfusion in Kidney Transplantation: Viability Assessment, Organ Rehabilitation, and the Move from Preservation to Active Graft Stewardship

  • 期刊论文

  • 发表日期：

    2026年7月1日

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  • Ali Muhtaroglu,
  • Serdar Acar,
  • Mert Adalı,
  • Berkan Acar,
  • Hanife Kole

摘要

Purpose of Review

Kidney machine perfusion has moved from a niche preservation tool to a central strategy for using higher-risk deceased donor kidneys. This narrative review examines how contemporary perfusion platforms are reshaping preservation, viability assessment and the emerging concept of organ rehabilitation in kidney transplantation.

Recent Findings

Continuous hypothermic machine perfusion now has the strongest clinical evidence and reduces delayed graft function in selected deceased-donor grafts. Oxygenated hypothermic perfusion and controlled oxygenated rewarming show increasingly supportive mechanistic and clinical signals, particularly in kidneys at greater ischaemic risk. Normothermic machine perfusion offers direct functional assessment and a platform for ex situ therapy, but the benefits of outcome remain less settled than early enthusiasm suggested. Across platforms, composite assessment models appear more defensible than single perfusion markers.

Summary

Ex situ perfusion is no longer simply a method of storage. It is becoming a platform for preservation, assessment, rescue of declining kidneys and targeted biological intervention. The next phase of the field will depend on standardised trial design, validated composite viability tools and service models that improve both organ utilisation and post-transplant outcomes.