Optimizing Donor Kidneys During Normothermic Machine Perfusion With Sevoflurane: Design of a Research Model

Normothermic machine perfusion (NMP) of donor kidneys provides an opportunity not only for organ preservation but also for therapeutic intervention to reduce ischemia-reperfusion injury (IRI) and support tissue repair. Sevoflurane, a volatile anesthetic known to protect against IRI in other organ systems, has not previously been explored in the context of kidney NMP. This study aimed to establish a stable and reproducible porcine kidney NMP model incorporating sevoflurane delivery. Different administration techniques and oxygenator setups were evaluated to identify the most effective method of sevoflurane application. Administering sevoflurane directly as a liquid into the perfusate resulted in excessive gas formation and unstable drug concentrations. In contrast, using a vaporizer connected to an Inspire 8F M oxygenator allowed for stable and reproducible sevoflurane levels over a 90-min perfusion period, while maintaining sufficient oxygenation. This method proved to be a reliable approach for sevoflurane delivery in kidney NMP. However, oxygenators exposed to sevoflurane should not be reused due to the risk of membrane damage. These findings support the feasibility of using sevoflurane in kidney NMP and provide a platform for further investigation into its potential to improve renal graft outcomes.