Introduction: In India, less than 5% of the ESRD population receive a kidney transplant. This prevailing shortage led to increased acceptance of kidneys from high-risk donors, e.g., the donor with acute kidney injury (AKI) and donation after uncontrolled circulatory death donors(uDCD). Application of Normothermic machine perfusion (NMP) can assess the functional viability of these grafts and can hasten early functional recovery after transplantation. However, literature regarding NMP application in kidney transplantation remains limited. We present our early preliminary experience with the usage of NMP in kidneys procured from deceased organ donors with successful kidney transplantation and describe their short-term outcomes.

Methods: Between December 2019- July 2021, consented recipients were eligible for inclusion if they had received AKI or uDCD grafts. Donor's kidneys underwent a two-hour of oxygenated NMP (based on Cambridge clinical trial protocol) with a red cell-based solution at 37°C after retrieval in addition to static cold storage (SCS). The main indication for NMP was to reduce the DGF amongst the AKI kidneys and organ viability assessment amongst the uDCD kidneys.

Results: Seven kidneys were transplanted into seven recipients after NMP (5 DBD+ 2uDCD [one en-block neonatal kidney]). The third uDCDwas discarded based on prolonged functional warm ischemia time (>2hrs) and poor, patchy perfusion on NMP. The primary function was observed in six recipients, and four had DGF. One recipient of uDCD kidney had graft loss due to invasive aspergillosis at 3-month post-transplant other six recipients are doing well with a baseline creatinine of (0.8-1.1mg/dl) on follow-up (12- 22 months) without any rejection episodes.

Conclusions: This pilot study showed the feasibility and utility of NMP in pretransplant reconditioning and viability assessment amongst AKI and uDCD grafts. NMP has the potential to increase the organ donor pool.