Renal transplantation: what has changed in recent years

Kidney transplantation is the best approved renal replacement therapy, although one of its biggest limitations remains a general organ donor shortage [1], not only in terms of absolute numbers, but particularly regarding preservation techniques. The concept of static cold storage has been proved to damage marginal organs that are increasingly being accepted to match the waitlist demand. Modern dynamic preservation technologies have developed in recent years not only to actively prevent kidney damage before transplantation, but also to assess potential organ viability. In this special issue, containing 12 manuscripts, we focus on hypothermic machine perfusion, showing in a matched observational study by M. I. Bellini et al. a higher eGFR at one-year followup with the dynamic preservation compared to static cold storage. Moreover, during hypothermic machine perfusion, resistive index predicted delayed graf function (DGF) with accuracy of 0.78 and 0.87 for organs from donation afer circulatory death (DCD) or afer brain death (DBD), respectively, and signifcantly decreased incidence of DGF in DCD organs.