First in Man Renal Transplantation After Ex Vivo Normothermic Perfusion

Background. Normothermic perfusion is an alternative but little studied method of organ preservation. Herein, we report the first case of ex vivo normothermic renal transplant perfusion in man. Methods. The 62-year-old extended criteria donor died of an intracranial hemorrhage and had undergone cardiopulmonary resuscitation for a 30-min cardiac arrest. After 11 hr of static cold storage and immediately before transplantation, the left kidney was perfused at a mean temperature of 33.9 degrees C for 35 min with a plasma-free red cell-based solution. The ex vivo perfusion circuit consisted of a centrifugal pump, a membrane oxygenator, and a heat exchanger. The paired right kidney underwent static cold storage for 14 hr. Results. After transplantation, the 55-year-old female recipient of the normothermic perfused kidney had slow graft function but the patient remained dialysis independent; serum creatinine at 3 months posttransplant was 132 mu mol/L. The paired static cold-stored kidney was transplanted into a 52-year-old male recipient. This kidney had delayed graft function for a period of 26 days, and the 3-month serum creatinine was 218 mu mol/L. Conclusion. We conclude that ex vivo normothermic kidney perfusion with a plasma-free red cell-based solution is a feasible method of preservation. This first case was performed without compromising the transplant kidney.