Kidney preservation in the next millenium

For the past decades, severe hypothermia has represented the foundation of organ preservation in clinical transplantation. Beneficial as hypothermia h as proven to be in preserving grafts from heart-beating donors, hypothermia does not seem to provide the window necessary for the prospective evaluati on of organ function. With the increasing use of non-heart-beating donors, it is logical to propose that if organs are to be evaluated prospectively, it will be necessary to preserve them at warmer temperatures. Since both gl omerular and tubular functions are inhibited at temperatures below 18 degre es C, such a goal will necessitate organ preservation at a temperature abov e 20 degrees C. The principle of preservation at warmer temperatures is not new, but with future developments and approaches, successful realization a ppears within reach. In this overview, a brief history of previous attempts at warm preservation, in the context of the current status of kidney prese rvation, is presented. Future developments and approaches, with the potenti al for prospective testing of the function and enhanced resistance to ische mic damage, will be discussed.