Introduction: Hypothermic oxygenated machine perfusion (HOPE) of kidneys is an effective way to preserve organs retrieved from extended criteria donors (ECD) and donors after circulatory death (DCD). This study presents preliminary results of HOPE prservation in kidney grafts from donors aged 65–72 years and donors who experienced out-of-hospital cardiac arrest.
Aim: To evaluate the diagnostic capabilities of HOPE and present the outcomes of kidney transplantation.
Materials and Methods: Between November 29, 2024, and March 31, 2025, a total of 26 HOPE procedures were performed, all kidneys were subsequently transplanted. 12 kidneys were obtained from ECD donors, of which 11 were older than 65 years old, and 8 were older than 70 years old. 10 kidneys were recovered from DCD donors, including 8 with out-of-hospital cardiac arrest. In 4 cases, HOPE was used to perfuse kidneys with hypoperfusion areas in standard donors. The median donor age was 63 [49–70] years old. The median cold ischemia time (including HOPE duration) was 1056.5 [898.5–1216.3] minutes. The median duration of HOPE was 129.5 [120–156.8] minutes. Resistance index (RI) was calculated as the ratio of perfusion pressure to perfusate flow rate to evaluate vascular status. The median RI was 0.53 [0.42–0.87].
Results: 19 recipients were male (73%), and 7 were female (27%), with a median recipient age of 54.5 [40–61] years old. 24 recipients received replacement renal therapy (RRT) via hemodialysis, 1 via peritoneal dialysis, and 1 had not undergone RRT. The median duration of RRT was 22 [12.5–47.8] months. Primary non-function (PNF) was observed in 4 recipients (15%), immediate graft function in 4 (15%), and delayed graft function (DGF) in 18 (70%). Median RI among PNF recipients was 0.7 [0.5–0.85], among DGF – 0.53 [0.33–1.03], and among recipients with immediate function – 0.41 [0.37–0.43]. A decrease in RI during HOPE procedure was observed in 75% of cases with immediate graft function, 39% with DGF, and 25% with PNF. Recipients with DGF required a median of 4 [4.25–4.75] hemodialysis sessions in the postoperative period before graft can be fully functional. 
Conclusions: The presented data indicate the effectiveness of HOPE as a diagnostic tool for pretransplant evaluation of kidney graft quality from extended criteria donors, including ECD and DCD donors.