Normothermic Kidney Perfusion: Current Status and Future Perspectives

Normothermic machine perfusion (NMP), the most recent advancement in solid organ preservation, enables ex situ maintenance of grafts in a physiologically active state, offering a significant advantage over traditional cold storage methods. Whereas NMP is now widely adopted for clinical preservation of livers, hearts, and lungs, its application in kidney transplantation remains relatively limited. In this context, NMP holds promise for expanding the use of marginal donor kidneys by enhancing viability assessment and potentially restoring function in grafts that might otherwise be discarded. In addition, NMP provides a valuable platform for studying molecular markers of injury and recovery in human organs, as well as for delivering targeted therapies aimed at modulating immunologic or transcriptomic profiles. Despite its potential, broader clinical implementation is hindered by variability in perfusion devices, protocols, and perfusate compositions across centers, making cross-study comparisons challenging. This review examines the current landscape of kidney NMP and its emerging role in graft reconditioning.