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Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion
Published on: April 27, 2015
Machine perfusion of the liver: past, present and future
Diethard Monbaliu1, John Brassil
1Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Catholic University Leuven, Leuven, Belgium. Diethard.Monbaliu@uz.kuleuven.ac.be
Current Opinion in Organ Transplantation
|February 4, 2010
Summary
Machine perfusion shows promise for preserving donor livers, including those with damage, potentially improving transplant outcomes beyond simple cold storage. Further development is needed for widespread clinical adoption.
Area of Science:
- Organ transplantation
- Surgical innovation
- Graft preservation
Background:
- Simple cold storage (SCS) is the standard for liver preservation but has limitations.
- Machine perfusion (MP) offers potential advantages for preserving livers, especially those with steatosis or ischemic damage.
- MP aims to improve graft viability, provide objective measures, and resuscitate suboptimal grafts.
Purpose of the Study:
- To review the potential of machine perfusion for liver preservation in clinical transplantation.
- To highlight significant achievements in liver machine perfusion over the past year.
- To assess MP's ability to improve outcomes compared to SCS and resuscitate grafts.
Main Methods:
- Review of current hypothermic (HMP) and normothermic (NMP) machine perfusion protocols.
- Analysis of studies demonstrating HMP's ability to increase energy stores and NMP's resuscitative potential.
- Examination of clinical and preclinical transplantations using HMP and NMP.
Main Results:
- HMP increases energy stores compared to SCS; NMP shows significant resuscitative effects on damaged grafts.
- Studies show successful transplantation of pig livers after HMP and NMP, avoiding graft failure seen with SCS alone.
- Clinical transplants have been performed after HMP, with NMP demonstrating clear resuscitative benefits.
Conclusions:
- Liver machine perfusion has advanced but lags behind kidney machine perfusion in clinical adoption.
- MP may soon return to clinical practice, but superiority alone is insufficient for immediate use.
- Clear benefits, usability, human factors, and innovative protocols are crucial for MP's widespread acceptance.
