Normothermic versus hypothermic machine perfusion in kidney transplantation: A randomized controlled trial

Julia S Slagter; Sarah Bouari; Elsaline Rijkse; Iacopo Cristoferi; Yitian Fang; Agni Papamanoli; Andrew Stubbs; Jeroen de Jonge; Ron W F de Bruin; Martijn W F van den Hoogen; Martin J Hoogduijn; Marian C Clahsen-van Groningen; Robert J Porte; Hendrikus J A N Kimenai; Robert C Minnee

doi:10.1016/j.ajt.2025.12.021

Normothermic versus hypothermic machine perfusion in kidney transplantation: A randomized controlled trial

Am J Transplant. 2025 Dec 24:S1600-6135(25)03191-0. doi: 10.1016/j.ajt.2025.12.021. Online ahead of print.

Authors

Affiliations

¹ Erasmus MC Transplant Institute, Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
² Erasmus MC Transplant Institute, Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands; Erasmus MC Transplant Institute, Department of Pathology and Clinical Bioinformatics, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
³ Erasmus MC Transplant Institute, Department of Pathology and Clinical Bioinformatics, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
⁴ Erasmus MC Transplant Institute, Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands.
⁵ Erasmus MC Transplant Institute, Department of Pathology and Clinical Bioinformatics, Erasmus MC University Medical Centre, Rotterdam, the Netherlands; Department of Medicine 2 (Medical Faculty), RWTH Aachen University, Aachen, Germany.
⁶ Erasmus MC Transplant Institute, Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands. Electronic address: r.minnee@erasmusmc.nl.

PMID: 41453736
DOI: 10.1016/j.ajt.2025.12.021

Abstract

Hypothermic machine perfusion (HMP) is considered the gold standard in kidney preservation. Despite this, grafts from extended criteria donor-donation after brain death, and donation after circulatory death, remain at high risk of delayed graft function. Normothermic machine perfusion (NMP) during the preservation process could alternatively preserve physiological activity. We investigated the value of additional NMP to HMP in extended criteria donor-donation after brain death and donation after circulatory death kidney transplantation. This is a single-center, open-label, superiority, randomized controlled trial. Patients were randomized to receive a kidney that was either preserved on HMP and 2 hours of end-ischemic HMP + NMP (intervention group) or HMP only (control group). The primary outcome was the incidence of immediate graft function. A total of 80 patients were included in the intention-to-treat analysis, of which 41 received a kidney that was preserved on HMP and HMP + NMP, and 39 received a graft that was preserved on HMP alone. Incidence of immediate graft function was 39% (16/41) in the HMP + NMP group compared with 49% (19/39) in the HMP group, with no significant difference between both groups (odds ratio, 0.68; 95% confidence interval, 0.28-1.64; P = .38). There was no statistically significant difference in any of the secondary outcomes. The addition of 2 hours of end-ischemic NMP does not improve early graft outcomes in kidney transplantation compared with HMP alone.