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The possible reno‐protective effect of a controlled brief heat‐shock treatment during isolated  ex vivo  machine perfusion of donor grafts prior to reperfusion should be investigated in a primary  in vitro  study. Porcine kidneys ( n  = 14) were retrieved after 20 minutes of cardiac standstill of the donor and subjected to 20 hours of static cold storage in University of Wisconsin solution. Prior to reperfusion, kidneys were subjected to 2 hours of reconditioning machine perfusion with gradual increase in perfusion temperature up to 35°C. In half of the kidneys ( n  = 7), a brief hyperthermic impulse (10 minutes perfusion at 42°C) was implemented in the machine perfusion period. Functional recovery of the grafts was observed upon normothermic reperfusion  in vitro . Hyperthermic treatment resulted in a 50% increase of heat shock protein (HSP) 70 and HSP 27 mRNA and was accompanied by ~ 50% improvement of tubular re‐absorption of sodium and glucose upon reperfusion, compared with the controls. Furthermore, renal loss of aspartate aminotransferase was significantly reduced to one‐third of the controls as was urinary protein loss, evaluated by the albumin to creatinine ratio. It is concluded that  ex vivo  heat‐shock treatment seems to be an easily implementable and promising option to enhance renal self‐defense machinery against reperfusion injury after preservation that merits further investigation in preclinical models.

Reduction of Renal Preservation/Reperfusion Injury by Controlled Hyperthermia During Ex Vivo Machine Perfusion