title: Kidney perfusion: some like it hot others prefer to keep it cool.
abstract: OBJECTIVE
  Machine perfusion technologies provide an opportunity for improved preservation, organ assessment, and resuscitation of damaged kidneys. This review summarizes the recent advances in hypothermic and normothermic kidney machine perfusion technologies.
  
  
  RESULTS
  Modifications to the perfusion conditions with the addition of oxygen during hypothermic machine perfusion can support a low level of metabolism, which in experimental settings improves graft function. Normothermic machine perfusion technologies are evolving in different directions including short-duration resuscitation, more prolonged periods of perfusion, and the transition between hypothermic and normothermic conditions. Clinical trials are ongoing in both hypothermic and normothermic settings. Functional parameters can be used to assess kidney quality and although normothermic machine perfusion may hold an advantage over hypothermic machine perfusion, new metabolomic, proteomic, and genomic technologies may be applied in the future to both technologies to provide more rigorous information on kidney quality. Promoting recovery by introducing an intervention during perfusion is an attractive area of research and therapies targeting the endothelium are a particular area of interest.
  
  
  CONCLUSIONS
  A great deal of research is still needed to optimize and logistically place hypothermic and normothermic perfusion technologies. In the future, we may progress toward organ-tailored preservation whereby high-risk kidneys can undergo assessment and repair before transplantation.
authors.affiliation: aDepartment of Microbiology and Immunology, Lab of Abdominal Transplant Surgery, KU Leuven bDepartment of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium cDepartment of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Ina
authors.initials: I
authors.lastname: Jochmans
authors.forename: Michael L
authors.initials: ML
authors.lastname: Nicholson
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Hosgood
mesh_terms: D005112:Extracorporeal Circulation / Q000379:methods*; D006801:Humans; D007668:Kidney / Q000473:pathology*; D016030:Kidney Transplantation / Q000379:methods*; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000379:methods*