*Purpose: Ischemia-reperfusion injury (IRI) has been considered an inevitable event in organ transplantation since the first successful kidney transplant was performed in 1954. To avoid IRI, we have established a novel procedure called ischemia-free organ transplantation. Here, we describe the first case of ischemia-free kidney transplantation (IFKT).

*Methods: The kidney graft was donated by a 19-year-old brain dead donor. The recipient was a 47-year-old man with end-stage diabetic nephropathy. The graft was procured, preserved and implanted without cessation of blood supply using normothermic machine perfusion.

*Results: The graft appearance, perfusion flow and urine production suggested the kidney was functioning well during the whole procedure. The creatinine dropped rapidly to normal range within three days post-transplantation. The levels of serum renal injury markers were low post-transplantation. No rejection, vascular or infectious complications occurred.

*Conclusions: This paper marks the first case of IFKT in humans. This innovation might offer a unique solution to optimize transplant outcomes in kidney transplantation.

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