SRS239 - Assessment and resuscitation by normothermic machine perfusion (NMP) allows the successful transplantation of kidneys from marginal donors that were initially deemed untransplantable

Abstract Background Kidney transplantation remains constrained by a shortage of suitable donor organs and every year several hundred donor kidneys are not transplanted because of concerns about their quality. Normothermic machine perfusion is an emerging technology that restores function ex vivo thus offering an objective pre-transplant assessment of donor organ quality and viability. Here, we describe a series of kidneys that were deemed unusable but rescued by NMP and successfully transplanted. Methods Kidneys enrolled into an RCT of cytokine filtration underwent a 4h period of NMP using a blood-based perfusate. Perfusion quality, renal blood flow (RBF), blood gases and lactate were assessed throughout the NMP period. Kidneys were also biopsied for an assessment of chronic damage using the Remuzzi score (RS). Kidneys with RS >4 or cold ischaemic time (CIT) of >24 h would normally be considered unsuitable for transplantation. Results 4/19 kidneys were initially deemed unsuitable for transplantation because of high RS (n = 2) or prolonged CIT (n = 2). All 4 kidneys demonstrated excellent perfusion and RBF after 4h NMP and were transplanted. One kidney underwent NMP in our centre and was transplanted in another UK centre. All NMP-rescued kidneys functioned with acceptable post-transplant GFRs. Conclusions Assessment by a 4h period of NMP led to the transplantation of kidneys that would otherwise have been discarded. We have also demonstrated, for the first time, proof-of-concept for establishing national assessment and resuscitation centres (ARCs) with potential for significant scalability to increase the utilisation of marginal kidneys.