Gabriel Oniscu

The growing need for kidney transplants, driven by an aging population and chronic diseases, has increased reliance on donors after circulatory death (DCD). DCD kidneys have higher rates of delayed graft function (DGF) and worse outcomes. The benefit of new machine perfusion technologies like normothermic regional perfusion (NRP) for kidney transplantation (KTx) outcomes, or the combined effect of NRP with ex situ hypothermic machine perfusion (HMP) remains unknown despite recent meta-analyses. Furthermore there is limited evidence for the benefit of adding oxygen during HMP (HMPO₂).As all Swedish centres have now gained access to these technologies, this grant aims to undertake a pilot study to compare the impact of NRP alone or NRP + hypothermic machine perfusion with oxygen (HMPO₂) on kidney function and transplant outcomes. Based on this pilot we aim to:1. Undertake a rigorous planning for a prospective Swedish Radomised trial.2. Ensure the national infrastructure and collaboration between the four centres is ready to facilitate the study3. Refine the design and underpin power calculations4. Mitigate the challenges in delivering such a study and ensure technology is well absorbed by the centres to minimise technical issues.To achieve our aims a constellation of clinical actors from all centres together with patients groups representation will lead the study planning and design (3 months), the delivery of the pilot (6 months) and planning of the clinical study (3 months).