Metabolic needs of the kidney graft undergoing normothermic machine perfusion

Asel S. Arykbaeva, Dorottya K. de Vries, Jason B. Doppenberg, Marten A. Engelse, Thomas Hankemeier, Amy C. Harms, Leonie G. Wijermars, Alexander F. Schaapherder, Jaap A. Bakker, Rutger J. Ploeg, Ian P. J. Alwayn, Jan H. N. Lindeman

Research output: Contribution to JournalReview articleAcademicpeer-review

5 Citations (Scopus)


Normothermic machine perfusion (NMP) is emerging as a novel preservation strategy. During NMP, the organ is maintained in a metabolically active state that may not only provide superior organ preservation, but that also facilitates viability testing before transplantation, and ex situ resuscitation of marginal kidney grafts. Although the prevailing perfusion protocols for renal NMP are refined from initial pioneering studies concerning short periods of NMP, it could be argued that these protocols are not optimally tailored to address the putatively compromised metabolic plasticity of marginal donor grafts (i.e., in the context of viability testing and/or preservation), or to meet the metabolic prerequisites associated with prolonged perfusions and the required anabolic state in the context of organ regeneration. Herein, we provide a theoretical framework for the metabolic requirements for renal NMP. Aspects are discussed along the lines of carbohydrates, fatty acids, amino acids, and micronutrients required for optimal NMP of an isolated kidney. In addition, considerations for monitoring aspects of metabolic status during NMP are discussed.
Original languageEnglish
Pages (from-to)301-310
Number of pages10
JournalKidney international
Issue number2
Early online date2021
Publication statusPublished - Aug 2021


  • kidney transplantation
  • machine perfusion
  • metabolism
  • normothermic
  • organ preservation

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