*Purpose: With the aim of safely expanding the pool of usable donors from circulatory death (DCD) there is increasing interest in normothermic regional (NRP) perfusion to assess and improve liver viability. NRP may also improve outcomes in kidney transplantation, however, a recent UK study raised potential concerns regarding early graft loss¹. We present our single centre experience of outcomes in imported kidneys following NRP.

*Methods: Data obtained from a prospectively maintained regional renal database between December 2012 and September 2018. Kidneys were retrieved and NRP performed by a single National Organ Retrieval Service (NORS) centre then transferred to our transplant unit. Primary endpoints were incidence and duration of delayed graft function (DGF) and estimated glomerular filtration rate (eGFR).

*Results: 817 kidneys were transplanted, 229 (28.3%) from DCD donors, 29 of which had NRP. Median donor age was lower for NRP (49.0 vs 50.0) and cold ischemic time shorter (09:18 vs 11:04). The DGF rate was lower for NRP vs DCD (14.8% vs 35.0%, p=0.048) with reduced duration of DGF (p=0.017). Multivariate analysis demonstrated transplant type to be a statistically significant independent predictor of eGFR in at 7 and 14 days. Early transplant function in NRP kidneys was comparable to DBD. The eGFR was higher up to 3 years post-transplant but not statistically significant when controlled for confounding factors. There were no graft losses within 30 days in the NRP group. One-year graft loss rate was 3.4% for NRP and 6.0% for standard DCD.

*Conclusions: NRP reduces rates of DGF and improved early renal function, reducing the impact of ischemia-reperfusion injury in DCD transplantation. This may be important in improving early outcomes of D3 and D4 kidneys with the new kidney matching scheme, a benefit not achieved with isolated normothermic perfusion of the liver².

References: 1. Oniscu G AJT 14:2846-2854 (2014) 2. Nasralla D Nature 557:50-56 (2018)

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