Background. Better preservation strategies for the storage of donation after circulatory
death grafts are essential to improve graft function and to increase the kidney donor
pool. We compared continuous normothermic ex vivo kidney perfusion (NEVKP) with hypothermic
anoxic machine perfusion (HAMP) and static cold storage (SCS) in a porcine kidney
autotransplantation model. Methods. Porcine kidneys were exposed to 30 minutes of
warm ischemia and then reimplanted following either 16 hours of either SCS, HAMP (LifePort
1.0), or NEVKP before autotransplantation (n = 5 per group). The contralateral kidney
was removed. Animals were followed for 8 days. Results. Grafts preserved by NEVKP
demonstrated improved function with more rapid recovery compared with HAMP and SCS
(mean peak serum creatinine: 3.66 +/- 1.33 mg/dL [postoperative d 1 [(POD1)], 8.82
+/- 3.17 mg/dL [POD2], and 12.90 +/- 2.19 mg/dL [POD3], respectively). The NEVKP group
demonstrated significantly increased creatinine clearance calculated on POD3 (63.6
+/- 19.0 mL/min) compared with HAMP (13.5 +/- 10.3 mL/min, P = 0.001) and SCS (4.0
+/- 2.6 mL/min, P = 0.001). Histopathologic injury scores on POD8 were lower in both
perfused groups (NEVKP and HAMP, score: 1-1.5) compared with SCS (score: 1-3, P =
0.3), without reaching statistical significance. Conclusions. NEVKP storage significantly
improved early kidney function compared with both cold preservation strategies, although
HAMP also demonstrates improvement over SCS. NEVKP may represent a novel, superior
preservation option for donation after circulatory death renal grafts compared with
conventional hypothermic methods.
