*Purpose: Recent studies have shown that ex vivo preservation at 37 º C can reduce kidney injury compared to current clinical practice. However, to mitigate metabolic demands at physiological temperature, perfusates are supplemented with insulin, glucose and amino acids to provide nutrition. Evidence suggests that nutritional supplementation during normothermic ex vivo perfusion improves organ preservation. However, it is unclear whether the same benefit is observed during room temperature oxygenated perfusion. In this study, we tested the impact of providing complete nutrition during ex vivo perfusion of DCD model donor kidneys for 12h at 22ºC.

*Methods: Porcine kidneys were recovered after 30min of cross clamping the renal artery in situ to simulate warm ischemic injury. After flushing with preservation solution, paired kidneys were cannulated and randomly assigned to perfusion with either 1) hemoglobin-based oxygen carrier HBOC or 2) HBOC + total parenteral nutrition (TPN) for 12h at 22ºC. To mimic reperfusion injury, all kidneys were reperfused with whole blood for an additional 4h at 37ºC. Kidney function and damage were assessed.

*Results: Kidneys preserved with or without TPN performed equally well, showing similar renal function post-reperfusion. Histological findings indicated similar levels of damage from apoptosis staining and acute tubular necrosis scores in both groups. Additionally, markers of renal damage (KIM-1) and inflammation (IL-6, HMGB-1) were similar between the groups.

*Conclusions: Our findings that nutritional supplementation does not warrant any additional benefit during ex vivo kidney preservation at near room temperature (22ºC) over 12 hr further contribute to the field of perfusate enhancement research in organ preservation. Additionally, this finding indicates that ex vivo perfusion may be more clinically feasible and cost-effective than previously thought if it is able to be carried out without the need for metabolic support.

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