LAUSR

T application of normothermic machine perfusion (NMP) machine technology as an assessment device may help to increase the utility of kidneys from uncontrolled donation after circulatory death (uDCD) donors. Here, we describe a case in which NMP perfusion characteristics were misleading and failed to predict primary nonfunction in 2 kidneys from a uDCD. The donor was a 37-y-old man who died of an intracerebral hemorrhage. Before withdrawal of life supporting treatment the donor had a cardiac arrest. He was rapidly transferred to the operating room and the abdominal organs cold perfused in situ with University of Wisconsin solution at 4°C. The first warm ischemic time was 27 min. Both kidneys appeared very poorly perfused and were further flushed on the back table with 4 L of hyperosmolar citrate solution over a period of 90 min. The appearance of both kidneys improved but they still remained patchy. The kidneys underwent a 1-h period of NMP as previously described. During NMP, the macroscopic appearance, renal blood flow, and urine output of both kidneys met our published criteria for transplantation (Table 1). The kidneys were transplanted into 2 separate nonsensitized recipients (Table 1). Immunological cross-matching was negative for both transplants. Both kidneys had a single renal artery and vein and these were anastomosed to the external iliac vessels. There was no intraoperative hypotension. A baseline biopsy taken from the left kidney 30 min after transplantation showed severe ischemic/reperfusion injury with almost all glomerular and peritubular capillaries filled with sludged red cells. Percutaneous needle core biopsies of both kidneys at day 8 showed infarction of the entire specimen. Computerized tomography angiography demonstrated patency of the main renal arteries and veins but diffuse poor parenchymal enhancement. In the absence of any improvement in renal function, primary nonfunction (PNF) was diagnosed in both kidneys at 3 mo. Extensive red cell plugging at revascularization led to cortical necrosis and allograft quality assessment by NMP failed to predict PNF. The young age of the donor and