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Updated: Feb 4, 2026

Author Spotlight: Advancements and Challenges in Machine Perfusion for Liver Transplantation
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Emerging Innovations in Liver Preservation and Resuscitation.

J Kim1, M A Zimmerman1, J C Hong1

  • 1Division of Transplant Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.

Transplantation Proceedings
|October 15, 2018
PubMed
Summary
This summary is machine-generated.

Machine perfusion (MP) improves outcomes for liver transplantation using marginal grafts, minimizing primary nonfunction and extending preservation time. This technology offers a vital tool for assessing graft viability and enabling interventions during organ shortage.

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Area of Science:

  • Hepatology
  • Transplantation Surgery
  • Organ Preservation

Background:

  • Marginal liver grafts are crucial for addressing organ shortages in orthotopic liver transplantation (OLT).
  • These grafts face higher risks of ischemia-reperfusion injury, primary nonfunction, and biliary complications.
  • Novel organ preservation and resuscitation methods are needed to improve OLT outcomes with marginal grafts.

Purpose of the Study:

  • To review the history and mechanisms of machine perfusion (MP) in OLT.
  • To evaluate the safety and feasibility of hypothermic and normothermic MP based on clinical trials.
  • To highlight recent advancements in MP for marginal liver graft utilization.

Main Methods:

  • Review of historical data and mechanisms of MP at different temperature settings (hypothermic, normothermic, midthermic/subnormothermic).
  • Analysis of 9 clinical trials investigating hypothermic and normothermic MP since 2010.
  • Inclusion of large animal studies and clinical trial data in OLT.

Main Results:

  • Machine perfusion demonstrated minimal primary nonfunction rates, even with marginal liver grafts.
  • MP allows for a reasonable increase in organ preservation time.
  • MP facilitates graft viability assessment and therapeutic intervention timing.

Conclusions:

  • Machine perfusion is a promising technology for improving OLT outcomes, particularly with marginal grafts.
  • Different MP temperature settings offer distinct advantages for organ preservation and assessment.
  • MP represents a significant advancement in managing organ shortages and enhancing transplantation success.