Abstract: Kidney transplantation remains the gold standard treatment for patients with end-stage renal disease.To address the growing demand for organs,there is an increasing reliance on organs from donors after cardiac death (DCD) and expanded criteria donors (ECD).These marginal organs are at a heightened risk of severe ischemia-reperfusion injury,which can lead to a higher incidence of primary nonfunction,delayed graft function,and reduced long-term graft survival rates following transplantation.Ex vivo machine perfusion (EVMP) provides superior protection for donor kidneys compared to traditional static cold storage.Additionally,EVMP can serve as a platform for the dynamic administration of drugs or gene therapies,further enhancing the efficacy of kidney transplantation.This review outlines innovative strategies for ex vivo kidney mechanical perfusion treatments,including mesenchymal stem cell therapy,gene therapy,nanotechnology,anti-infectives,gas therapy,thrombolytics,blood type conversion,and other therapeutic approaches.

Key words: kidney transplantation, ex vivo machine perfusion, hypothermic mechanical perfusion, normothermic mechanical perfusion