Background
Kidney transplantation remains the preferred treatment for many patients with end-stage kidney disease, offering better survival and quality of life than long-term dialysis. However, the success of transplantation depends heavily on the condition of the donor kidney and the amount of ischemic injury it experiences before implantation. This is especially relevant in donation after circulatory death (DCD), where kidneys are recovered after the donor’s heart has stopped. In DCD transplantation, a period of warm ischemia occurs before the organ can be cooled and preserved, and that injury can increase the risk of delayed graft function and, in some cases, long-term graft failure.
Normothermic regional perfusion (NRP) has emerged as a strategy to reduce this injury. In NRP, circulation is restored to the abdominal organs after circulatory death using extracorporeal support, while preserving ethical and legal boundaries regarding death determination. The goal is to improve organ quality by restoring oxygen delivery before procurement. Although NRP has been increasingly adopted, questions remain about how much it improves outcomes, whether a longer NRP period is better, and which patients benefit the most.
