Hypothermic kidney preservation: a remembrance of the past in the future?

PURPOSE OF REVIEW

Hypothermic static organ preservation remains the Standard of Care in renal transplantation. At the same time, novel perfusion and preservation concepts are under current investigation and have shown promising results.We summarize the current knowledge and controversies in hypothermic kidney preservation.

RECENT FINDINGS

The ideal organ perfusate remains a matter of ongoing debate and prospective randomized clinical trials supporting the superiority of one organ preservation solution remain limited. Ideally, a concept of one preservation solution serving the needs of all organs may best serve practicality and cost-effectiveness. At the same time, organ-specific aspects and the role of organ quality linking perfusion and preservation continue to be discussed controversially.Hypothermic pulsatile perfusion has gained increasing attention with some of the recent clinical trials demonstrating improved transplant survival. However, not all recent clinical studies have been in support of machine perfusion and preservation. Composition of the perfusate, potential benefits of oxygenation, length of preservation, and dissecting a potential advantage of pulsatile over continuous flow patterns will be additional critical steps in working towards an optimized organ preservation. At the same time, studies into mechanisms and indications for pulsatile perfusion will need more attention.

SUMMARY

Organ preservation is a critical aspect for the overall success in organ transplantation. The current increased utilization of reduced quality kidneys will require us to further improve our practice and knowledge into optimized organ preservation concepts and their impact on transplant outcome and immune responsiveness.