Hypothermic machine perfusion in liver transplantation.

Area of Science:

• Organ transplantation
• Machine perfusion technology
• Graft preservation

Background:

• Human application of hypothermic machine liver perfusion (HMP) is limited.
• Three transplant centers currently use HMP for donation after cardiac death (DCD) or donation after brain death (DBD) liver grafts.
• Endischemic perfusion is applied after cold storage for organ transport.

Purpose of the Study:

• To review recent human applications of HMP.
• To discuss potential protective mechanisms of HMP.
• To evaluate the impact of HMP on liver graft quality and outcomes.

Main Methods:

• Review of human applications of HMP in liver transplantation.
• Analysis of perfusion conditions including oxygenation, perfusion route, duration, and perfusate.
• Evaluation of graft function and complications post-transplantation.

Main Results:

• HMP is applied in DCD and DBD liver grafts, with endischemic perfusion post-cold storage.
• Perfusion parameters vary slightly across transplant centers.
• Preliminary data suggest HMP protects against initial reperfusion injury in extended criteria DBD and DCD livers.

Conclusions:

• Endischemic HMP shows potential in protecting extended criteria DBD and DCD livers from reperfusion injury.
• HMP may improve graft function and reduce biliary complications.
• HMP is a practical technique that could expand the donor pool; multicenter trials are underway.