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Updated: Mar 14, 2026
Ex Situ Normothermic Machine Perfusion of Donor Livers
Published on: May 26, 2015
[Ischemia-reperfusion. Preservation solution and hypothermic machine perfusion]
B Barrou1, N Chatauret2, T Hauet3
1Département d'urologie, néphrologie et transplantation rénale, GH Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Faculté de médecine, université Paris VI Pierre-et-Marie-Curie, 91-105, boulevard de l'Hôpital, 75013 Paris, France; Inserm U 1082 Poitiers, INRA plateforme IBiSA, 17700 Surgères, France.
Aims:
To describe ischemia-reperfusion mechanisms, the impact on kidney graft and strategies developed to minimize ischemia-reperfusion damages.
Material And Methods:
An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords: ischemia-reperfusion; organ preservation; hypothermic machine perfusion; renal transplantation. Publications obtained were selected based on methodology, language, date of publication and relevance. Prospective and retrospective studies, in English or French, review articles; meta-analysis and guidelines were selected and analyzed. This search found 1293 articles. After reading titles and abstracts, 88 were included in the text, based on their relevance.
Results:
Ischemia-reperfusion injuries occur when blood supply of an organ is interrupted or drastically reduced. Ischemic damages started immediately after arterial clamping in donor, persist during cold ischemia time, and are increased after reperfusion because of increased oxygen levels, organ warming and recipient cell infiltration. Besides metabolic and biologic impact, IR induced dramatic immunologic impact through immunologic cells activation.
Conclusions:
Knowledge of IR mechanisms is crucial to improve organ storage strategies and to decreased impact of IR on long-term graft and patient survival. Hypothermic machine perfusion was associated with prolonged graft survival versus cold storage. Principles and results of hypothermic machine perfusion will be reported.
