Introduction: Normothermic machine perfusion (NMP) is a technique gaining popularity to improve use of marginal deceased organs and reduce ischemic reperfusion injury. This study aimed to determine the feasibility and acceptance of NMP protocol in a single institution.

Methods: From 2017-2020 inclusive, NMP was introduced to the unit in three phases: Pre-clinical, ethics approval with establishment of Kidney assist device (Groningen, Netherlands), establishment of a feasibility study (NEXT Kidney Trial) to establish suitability in routine use. Thus far, we have enrolled a total of 13 patients who received donor kidneys with ex-vivo normothermic machine perfusion between Nov 2020 and February 2022.

Results: The pre-clinical phase involved three years experience using back-bench prepared normothermic machine perfusion adapted from existing cardiopulmonary bypass pump device. Initially it utilised porcine, and later discarded human kidneys to establish protocol and fluid constituent to be utilised. Clinical introduction had two components: device training and device learning curve (n=2 cases). Transplant coordinators and perfusionists experienced with pre-clinical and clinical component of the device introduction were critical to the feasibility study. 13 deceased donor kidney transplants occurred using donors after circulatory determinant of death (DCD), The mean age was 44.8 years old, with average warm donor ischemia time of 17.1 minutes. The median kidney donor profile index (KDPI) was 66. Of these, 8 (62%) had primary function and 5 (38%) experienced delayed graft function (DGF) and required dialysis within 7 days post transplants. Of patients with DGF, the median number of dialysis sessions was x1. The average NMP time was 65.3 minutes. There was one case where the NMP developed low flow at 54 minutes into the perfusion which subsequently developed DGF. The mean recipient age was 44.8 years old. Mean cold ischemia time (CIT) and secondary warm ischemia time (SWIT) were 485 min (SD 127min) and 19.8 min  (SD 2.79min) respectively. Incidence of delayed graft function was 38% (n=5), presented in table 1.  Mean CIT for DGF and IGF was 494min and 470min The mean terminal donor creatinine for DGF and IGF cohorts were 135micromol/L and 97 micromol/L.

Conclusion: Utilisation of NMP protocol into an established kidney transplantation unit is feasible based on early clinical results. A multidisciplinary approach involving experienced perfusionists, transplant coordinators and physicians is critical to the success of the program.