Normothermic Machine Perfusion of Kidney Grafts: Devices, Endpoints, and Clinical Implementation

Summary Background Normothermic machine perfusion (NMP) has emerged as a promising technique for preserving and reconditioning kidney grafts before transplantation. By providing continuous oxygenated, nutrient-rich perfusion at 37 °C, NMP mimics physiological conditions, potentially improving graft viability and function. Over the past decade, NMP has demonstrated safety and feasibility in experimental and clinical settings. Methods A comprehensive literature search was performed to identify commercially available and clinically applied kidney NMP devices as well as endpoints from planned, ongoing, and completed clinical trials on kidney NMP. Results This review presents an in-depth analysis of NMP technology in experimental and clinical kidney transplantation. It details the features and evidence supporting commercial and experimental perfusion devices and discusses clinical trial endpoints relevant to kidney NMP. Key technical limitations and knowledge gaps are identified, including variability in perfusion strategies and perfusate composition. Conclusion Despite significant advancements, the optimal perfusion strategy and perfusate composition for kidney NMP remain undefined. Further preclinical studies and well-designed clinical trials are essential to address these gaps and establish NMP as a reliable tool for improving outcomes in kidney transplantation.