Prolonged normothermic perfusion of the kidney prior to transplantation: a historically controlled, phase 1 cohort study
Kidney transplantation is the preferred treatment for end-stage renal disease and is limited by donor organ availability. Normothermic Machine Perfusion (NMP) might facilitate safe transplantation of marginal organs. NKP1 is a single centre, phase 1, 36-patient, three-stage cohort study investigating the safety and feasibility of up to 24 hours of renal NMP prior to transplantation. 30-day graft survival (primary endpoint) was 100%. Secondary objectives were assessment of the effect of NMP on post-transplant clinical outcomes and ischaemia-reperfusion injury, identification of predictive biomarkers, and characterisation of the performance of the preservation system. Clinical outcomes were comparable to a matched control cohort with 12-month estimated glomerular filtration rate (eGFR) 46.3 vs 49.5 mL/min/1.73m<sup>2</sup> (p = 0.44) despite much longer total preservation times (15.7 vs 8.9 hours controls, p < 0.0001). We saw strong correlations between biomarkers measured ex-situ and post-transplant outcomes, including graft function at one year (correlation between GST-Pi delta and 12-month eGFR, R = 0.54, p = 0.001). Renal NMP is useful for optimising logistics and as an organ assessment technique, and has potential to expand the donor pool. Trial registration number: ISRCTN13292277.
Authors
- Daniel Voyce
- Richard Dumbill (ORCID: https://orcid.org/0000-0003-1907-4758)
- S. A. Roberts (ORCID: https://orcid.org/0000-0002-7477-7731)
- James Hunter (ORCID: https://orcid.org/0000-0002-4972-6879)
- Elizabeth J. Conroy (ORCID: https://orcid.org/0000-0003-4858-727X)
- Rutger J. Ploeg (ORCID: https://orcid.org/0000-0001-7801-665X)
- Constantin Coussios (ORCID: https://orcid.org/0000-0001-8792-7818)
- Peter John Friend (ORCID: https://orcid.org/0000-0003-0841-9685)
- Tim James (ORCID: https://orcid.org/0000-0002-5382-9838)
- Annemarie Weißenbacher (ORCID: https://orcid.org/0000-0002-0582-1815)
- Simon Knight (ORCID: https://orcid.org/0000-0003-4837-9446)
- Matt Ellen
- Jacob Barrett
- John Fallon (ORCID: https://orcid.org/0000-0002-8644-9380)
- Gabrielle Allen
Institutions
- Innsbruck Medical University (AT)
- Universität Innsbruck (AT)
- Nuffield Orthopaedic Centre (GB)
- University Hospitals Coventry and Warwickshire NHS Trust (GB)
- University of Oxford (GB)
- OrganOx (United Kingdom) (GB)
- Science Oxford (GB)
- Oxford University Hospitals NHS Trust (GB)
Publication Details
- Journal
- Nature Communications
- Published
- 2025-05-16
- DOI
- https://doi.org/10.1038/s41467-025-59829-5
- Citations
- 24
- Primary Topic
- Organ Transplantation Techniques and Outcomes
- Type
- article
- Field-Weighted Citation Impact
- 48.15
Funders
- United Kingdom Clinical Research Collaboration
- Cancer Research UK
- National Institute for Health and Care Research
- Department of Health and Social Care
- University of Oxford
- Oxford University Hospitals NHS Foundation Trust
- Invention for Innovation Programme
- Invention for Innovation
- NIHR Oxford Biomedical Research Centre