Ischemia-free organ transplantation - a review

Organ transplantation is one of the miracles in medicine in the 20th century. However, in the current practice, all the donor organs suffer from ischemia/reperfusion injury (IRI), which compromise transplant outcomes and limits organ availability. Continuous efforts have been made in organ machine perfusion to ameliorate IRI. In 2017, ischemia-free organ transplantation (IFOT) was first proposed with the aim of complete avoidance of IRI in organ transplantation. The purpose of this review is to highlight the latest progresses in IFOT.

The feasibility of IFOT has been validated in liver, kidney, and heart transplantation. The results of the first nonrandomized controlled study demonstrate that ischemia-free liver transplantation (IFLT) may improve transplant outcomes and increase organ availability. Furthermore, laboratory results, including the absence of the characteristic pathological changes, gene transcription and metabolic reprogramming, as well as sterile inflammation activation in IFLT grafts, suggest the virtual avoidance of graft IRI in IFLT.

IFOT might change the current practice by abrogating graft IRI. IFOT also provides a unique model to investigate the interaction between allograft IRI and rejection. The next steps will be to simplify the technique, make long-distance transportation possible and evaluate cost-effectiveness.