Advances in kidney preservation techniques and their application in clinical practice

The use of cold preservation solutions to rapidly flush and cool the kidney followed by static cold storage (SCS) in ice has been the standard kidney preservation technique for the last 50 years. Nonetheless, changing donor demographics that include organs from extended criteria donors (ECDs) and donation after circulatory death (DCD) donors have led to the adoption of more diverse techniques of preservation. Comparison of hypothermic machine perfusion (HMP) and SCS techniques for deceased donor kidneys has long been debated and is still contested by some. The recent modification of HMP techniques with the addition of oxygen or perfusion at sub-normothermic or near-normothermic temperatures are promising strategies that are emerging in clinical practice. In addition, the use of normothermic regional perfusion (NRP) to resuscitate abdominal organs of DCD donors in situ prior to cold flushing is also increasingly being utilised. This review provides a synopsis of the different types of preservation techniques including their mechanistic effects and the outcome of their application in clinical practice for different types of donor kidney.Supplemental Visual Abstract; http://links.lww.com/TP/C142.