Machine Perfusion for Extended Criteria Donor Livers: What Challenges Remain?

Area of Science:

• Hepatology
• Transplant Surgery
• Organ Preservation

Background:

• Extended criteria donor (ECD) livers are increasingly utilized due to advances in dynamic preservation.
• Static cold storage (SCS) has limitations for these organs, leading to higher risks of graft dysfunction and complications.
• Dynamic preservation techniques offer a platform for organ reconditioning and viability assessment.

Purpose of the Study:

• To critically review the clinical use and outcomes of ECD livers preserved with SCS.
• To explore the potential role of machine perfusion techniques in improving outcomes for marginal livers.
• To discuss future strategies for increasing the utilization of the donor organ pool.

Main Methods:

• Literature review of current clinical practices and outcomes for ECD liver transplantation.
• Discussion of challenges associated with SCS for marginal grafts.
• Analysis of the benefits and limitations of various dynamic preservation strategies.

Main Results:

• ECD livers present unique challenges, with SCS associated with increased risks of graft dysfunction and biliary complications.
• Dynamic preservation techniques show promise in mitigating reperfusion injury and assessing organ viability.
• Ongoing debate exists regarding the optimal perfusion strategies for different categories of marginal livers (e.g., DCD, DBD, steatotic).

Conclusions:

• Dynamic preservation offers a valuable alternative to SCS for marginal donor livers, potentially improving transplant outcomes.
• Machine perfusion techniques are crucial for evaluating and improving the quality of ECD livers.
• Further research and optimized strategies are needed to maximize the utilization of the donor organ pool.