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Machine Perfusion: Cold versus Warm, versus Neither. Update on Clinical Trials
E Bonaccorsi-Riani1,2, I M A Brüggenwirth3, J E Buchwald4
1Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
Seminars in Liver Disease
|June 20, 2020
Summary
Machine perfusion (MP) offers a promising approach for liver transplantation, enhancing organ preservation and evaluation. While feasible and safe, further high-quality trials are needed to establish its superiority over traditional methods.
Area of Science:
- Transplantation immunology
- Organ preservation techniques
- Surgical innovation
Background:
- Machine perfusion (MP) represents a significant advancement in liver transplantation over the past two decades.
- It is a promising strategy for improving the preservation and ex situ assessment of extended criteria donor (ECD) livers.
- MP introduces considerable costs and logistical complexities.
Purpose of the Study:
- To provide an overview of preclinical studies and clinical trials on machine perfusion for liver preservation.
- To discuss the results, protocols, and challenges associated with MP in liver transplantation.
- To highlight the need for rigorous study design to establish MP as a potential gold standard.
Main Methods:
- Review of preclinical studies utilizing discarded human livers.
- Analysis of published clinical trials investigating liver MP.
- Description of hypothermic (HMP) and normothermic (NMP) machine perfusion protocols.
Main Results:
- MP has demonstrated feasibility and safety in clinical settings following extensive preclinical research.
- Current clinical trials, though numerous, lack compelling evidence of MP's superiority in preservation quality.
- Liver MP is still considered experimental in many regions, necessitating further investigation.
Conclusions:
- MP preservation is advancing, with ongoing studies aiming to confirm its benefits in clinical outcomes, organ utilization, and cost-effectiveness.
- Challenges in MP study design, including the need for randomized trials and robust data interpretation, must be addressed.
- Generating high-quality evidence is crucial to determine if MP will become the new gold standard for liver preservation.
