Transplantation is the optimal treatment for most patients with end stage kidney disease but organ shortage is a major challenge. A new technique, normothermic machine perfusion (NMP) has been used to re-condition marginal organs however mechanisms by which NMP might benefit organs are not well understood. Using pairs of human kidneys obtained from the same donor, the authors compared the effect of NMP with that of cold storage on global kidney transcriptome. Cold storage led to the global reduction in gene expression, including inflammatory pathway genes. In contrast NMP, led to upregulation of the OXPHOS genes (required for energy generation processes), but also of a number of immune and inflammatory pathway genes. Using biopsies from kidneys undergoing NMP that were subsequently transplanted, the authors found that higher inflammatory gene expression occurred in organs with prolonged delayed graft function (DGF). Therefore, CytoSorb was used to remove pro-inflammatory cytokines for a period of 4 hours. Use of CytoSorb attenuated the negative effects of immune gene induction, and increased OXPHOS pathway genes. There were no effects on renal blood flow, urine output or composition, oxygen consumption or acid-base homeostasis. The authors suggest that their data shows that adsorption of pro-inflammatory mediators from the perfusate represents a potential intervention which may improve organ viability, including also liver and lung transplantation.

Link: https://pubmed.ncbi.nlm.nih.gov/33098231/