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Ex Situ Normothermic Machine Perfusion of Donor Livers
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Hypothermic Oxygenated Liver Perfusion: Basic Mechanisms and Clinical Application.

A Schlegel1, P Kron1, P Dutkowski1

  • 1Department of Surgery and Transplantation, University Hospital Zürich, Raemistr. 100, 8091 Zurich, Switzerland.

Current Transplantation Reports
|June 23, 2015
PubMed
Summary

Hypothermic machine perfusion (HMP) is a dynamic strategy to enhance liver graft quality for transplantation. This review covers HMP optimization, graft assessment, injury protection, and clinical uses.

Keywords:
Hypothermic oxygenated perfusionIschemia-reperfusion injuryMitochondriaROS

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Area of Science:

  • Hepatology
  • Transplantation immunology
  • Organ preservation technologies

Background:

  • Liver transplantation is a life-saving procedure, but graft availability and quality remain critical challenges.
  • Standard static cold storage has limitations in preserving liver graft viability and function.
  • Dynamic preservation methods, like hypothermic machine perfusion (HMP), are emerging as promising alternatives.

Approach:

  • This review synthesizes current scientific literature on hypothermic machine perfusion for liver preservation.
  • It examines the optimization of perfusion parameters and methods for assessing graft quality during perfusion.
  • The review also explores protective mechanisms against ischemia-reperfusion injury and recent clinical applications.

Key Points:

  • Optimizing perfusion conditions (e.g., temperature, perfusate composition, flow dynamics) is crucial for HMP effectiveness.
  • In-perfusion assessment of graft viability (e.g., biochemical markers, functional tests) can guide transplantation decisions.
  • Understanding pathways to mitigate ischemia-reperfusion injury is key to improving post-transplant outcomes.
  • Recent clinical studies demonstrate the feasibility and potential benefits of HMP in human liver transplantation.

Conclusions:

  • Hypothermic machine perfusion represents a significant advancement in liver graft preservation, potentially improving outcomes.
  • Further research and standardization of HMP protocols are needed to maximize its clinical impact.
  • HMP offers a platform for ex vivo graft assessment and intervention, moving beyond static preservation.