Normothermic Machine Perfusion and Inflammatory Mediators Adsorption: First Kidney Transplant Experience

: Kidney transplantation faces challenges due to the shortage of donor organs, leading to the increased use of extended criteria donor (ECD) organs. Recent advancements in ex-situ organ perfusion technologies have facilitated the use of ECD kidneys by preserving organs in near-physiological conditions to tackle ischemia-reperfusion injury (IRI), a process that leads to long-term graft injury. This study focuses on the application of an inflammatory mediators' removal (IMR) integrated in a normothermic machine perfusion (NMP) for the recovery of an ECD kidney before transplantation. This IMR device, designed to adsorb inflammatory molecules, demonstrated effective removal of cytokines during the perfusion process. An ECD kidney underwent 320 minutes of NMP, allowing detailed organ viability assessments and cytokine modulation. A significant volume of urine output and successful post-transplantation outcomes, with no delayed graft function (DGF), highlight the efficacy of this approach. Additionally, the adsorption of inflammatory cytokines was characterized by concentration-dependent removal, suggesting a balanced modulation of both pro- and anti-inflammatory responses. The integration of IMR device into the perfusion process might offer a promising option for evaluating organ viability and mitigating IRI. Further studies are needed to explore the long-term clinical impact of this approach on graft survival and function.