Purpose of review: The purpose of this review was to summarize the novel developments in preservation of older kidneys.
Recent findings: The importance of older donors as a source of renal grafts is increasing, with a concomitant increase of posttransplant failure. Preservation of kidneys retrieved from older donors through hypothermic machine perfusion reduces delayed graft function rate and increases long-term graft survival. Assessment of renal function and selection through biomarkers or perfusion criteria to predict posttransplant function are limited. Normothermic perfusion offers the benefit of reperfusion under ideal circumstances, thereby reducing ischemic injury while having the opportunity to test graft viability and preselect kidneys on graft-specific characteristics. Both preservation methods enable active treatment of the isolated graft prior to transplantation, with stem cells or pharmaceuticals.
Summary: Older kidneys are more prone to acute kidney injury during ischemic periods combined with an impaired ability to fully recover after transplantation. Novel preservation and resuscitation methods provide the opportunity to select transplantable kidneys better founded or even repair re-existing damage reducing the risk of impaired graft function and improving survival.