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Hypothermic machine perfusion (HMP) of kidneys is a long-established alternative to static cold storage and has been suggested to be a better preservation method. Today, as our deceased donor profile continues to change towards higher-risk kidneys of lower quality, we are confronted with the limits of cold storage. Interest in HMP as a preservation technique is on the rise. Furthermore, HMP also creates a window of opportunity during which to assess the viability and quality of the graft before transplantation. The technology might also provide a platform during which the graft could be actively repaired, making it particularly attractive for higher-risk kidneys. We review the current evidence on HMP in kidney transplantation and provide an outlook for the use of the technology in the years to come.

Original publication




Journal article


Transpl Int

Publication Date





665 - 676


delayed graft function, donation after brain death, donation after circulatory death, expanded criteria donors, extended criteria donors, graft quality, history of machine perfusion, hypothermic machine perfusion, kidney transplantation, organ preservation, perfusate biomarkers, renal resistance, viability assessment, Cold Temperature, Donor Selection, Drug Delivery Systems, Genetic Therapy, Graft Survival, Humans, Kidney Transplantation, Organ Preservation, Organ Preservation Solutions, Oxygen, Perfusion, Randomized Controlled Trials as Topic, Stem Cell Transplantation, Tissue Donors, Treatment Outcome