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Review
. 2025 Jun 26;10(9):2943-2952.
doi: 10.1016/j.ekir.2025.06.041. eCollection 2025 Sep.

Normothermic Kidney Perfusion: Current Status and Future Perspectives

Barbara Franchin  1 , Leonie van Leeuwen  2 , Matthew L Holzner  2 , Nicholas Chun  1 , Lucrezia Furian  3 , Paolo Cravedi  1
Affiliations
Review

Normothermic Kidney Perfusion: Current Status and Future Perspectives

Barbara Franchin et al. Kidney Int Rep. .

Abstract

Normothermic machine perfusion (NMP), the most recent advancement in solid organ preservation, enables ex situ maintenance of grafts in a physiologically active state, offering a significant advantage over traditional cold storage methods. Whereas NMP is now widely adopted for clinical preservation of livers, hearts, and lungs, its application in kidney transplantation remains relatively limited. In this context, NMP holds promise for expanding the use of marginal donor kidneys by enhancing viability assessment and potentially restoring function in grafts that might otherwise be discarded. In addition, NMP provides a valuable platform for studying molecular markers of injury and recovery in human organs, as well as for delivering targeted therapies aimed at modulating immunologic or transcriptomic profiles. Despite its potential, broader clinical implementation is hindered by variability in perfusion devices, protocols, and perfusate compositions across centers, making cross-study comparisons challenging. This review examines the current landscape of kidney NMP and its emerging role in graft reconditioning.

Keywords: ex situ perfusion; graft recovery; ischemia-reperfusion injury; kidney transplantation; marginal donors; target-therapies.

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Figures

Figure 1
Figure 1
Schematic representation of NMP circuit. (1) Continuous or pulsatile pump, (2) oxygenator, (3) organ chamber, (4) urine collector, (5) infusions, (6) screen providing hemodynamic parameters measured by in line sensors, and (7) Heater. NMP, normothermic kidney perfusion.
Figure 2
Figure 2
Key takeaways. NMP, normothermic kidney perfusion; NRP, normothermic regional perfusion; SCS, static cold storage.
See this image and copyright information in PMC

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