腎移植におけるMachine Perfusionの現状

抄録

The insufficient number of grafts is a major problem in kidney transplantation, and graft preservation with ex vivo machine perfusion is attracting attention to facilitate kidney donation from so-called marginal donors, such as those with acute kidney injury and/or an older age. Since 1985, several clinical trials have been conducted comparing kidney graft preservation between cold machine perfusion and simple cold preservation in several renal transplant centers. However, the results have not contributed to the widespread clinical used of machine perfusion, as most of the studies were relatively small in scale and did not yield definitive results that preservation with cold machine perfusion was superior. In 2009, an international randomized controlled trial by Moers et al. reported that kidney graft preservation with cold machine perfusion reduced the risk of a delayed graft function, decreased serum creatinine levels, and significantly improved the one-year graft survival compared to simple cold storage. Since then, kidney graft preservation with cold machine perfusion using the LifePort Kidney Transporter machine has been clinically applied worldwide. In addition, clinical trials of normothermic machine perfusion as a next-generation preservation method are underway to promote the clinical application of renal transplantation. Following the first clinical application in 2011 and a clinical study in 2013 using normothermic machine perfusion in the United Kingdom, the results of a clinical trial of graft preservation with normothermic machine perfusion in renal transplantation in North America and India were reported in 2022. Graft preservation with ex vivo machine perfusion is expected to help solve the global shortage of kidney grafts.