![]() ![]() 8, 9 Therefore, we performed a systematic qualitative review aimed to compare relevant outcomes of HMP and NMP of porcine kidneys. Limited data on human studies comparing HMP to NMP are available so far, with most studies focusing on NMP being conducted in porcine animal models as porcine kidneys are very similar to human kidneys in size, physiology, and anatomy. Hosgood and colleagues have used NMP to assess and improve the function of declined kidney grafts and have successfully transplanted 4 of 10 initially declined kidneys, 7 proving that better preservation methods could help reduce the imbalance between supply and demand of suitable kidney grafts. 7 This could theoretically result in less ischemia-reperfusion injury, and therefore a better survival after donation after circulatory death (DCD) and use of expanded criteria donors (ECD). 6 NMP offers the unique ability to fully assess kidney function and viability by allowing the restoration of the renal aerobic metabolism, as it most closely resembles the physiological environment of the kidney. Normothermic machine perfusion (NMP) is a promising alternative to HMP for kidney preservation, and the first clinical studies comparing NMP to HMP have already started. Kidney preservation methods need to be improved to deal with the increasing number of marginal donor kidneys. ![]() 2- 5 With HMP, limited viability assessment is possible, as cellular metabolism is still present. ![]() 1 HMP can be applied both with and without the addition of oxygen (hypothermic oxygenated perfusion, HOPE) the addition of oxygen had a beneficial effect on early graft function in animals. HMP has been shown to reduce graft injury, lower delayed graft function (DGF) rates, and lead to better transplant outcomes. While static cold storage (SCS) is still the golden standard worldwide for kidney preservation prior to transplantation due to its easy availability and low costs, hypothermic machine perfusion (HMP) is increasingly being used and is already the standard of care in the Netherlands. The results need to be interpreted with caution in view of the diversity in perfusion protocols, the low quality of evidence, and the limited sample sizes. None of the studies found a significant difference between NMP and HMP in peak serum creatinine or graft survival after autotransplantation. Two out of 4 studies reported a higher degree of epithelial vacuolation in kidneys receiving NMP over HMP. Peak creatinine clearance in NMP was significantly higher than that in HMP in 1 out of 6 studies. Oxygen consumption was significantly higher in NMP kidneys in 2 out of 5 studies. One out of 5 studies reported a significant difference in peak renal blood flow in favor of NMP. The quality of evidence of each included study was assessed. A meta-analysis was judged inappropriate because of heterogeneity in study design and perfusion methods. We conducted a systematic literature review in Embase, Medline Epub (Ovid), Cochrane Central, Web of Science, and Google Scholar on studies comparing normothermic (NMP) to hypothermic machine perfusion (HMP) in porcine kidneys. We present an updated overview of the literature comparing normothermic with hypothermic machine perfusion in porcine kidneys. ![]()
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