Should Pulsatile Preservation Be the Gold Standard in Kidney Transplantation?

In recent years, dramatic improvements in kidney transplantation, together with a rising incidence of diseases such as diabetes, have led to an increasing demand for deceased donor kidneys for transplantation. Hence, it has been necessary to expand the kidney donor pool by using organs once considered unsuitable for transplantation. These higher risk kidneys are typically from older donors with additional comorbidities and are more susceptible to injury. Therefore, the transplant community has been focusing efforts in trying to improve the outcomes of these high-risk organs. Preservation by pulsatile machine perfusion has been associated with decreased risk of delayed graft function and renoprotective effects on deceased donor kidneys. The aim of this review is to provide an overview of the principles of this preservation technique and to review the evidence regarding its usage for deceased donor kidneys compared to standard static cold storage.