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Updated: Jun 28, 2025
Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion
Published on: April 27, 2015
Efficiency of machine perfusion in pediatric liver transplantation
Alessandro Parente1,2, Mureo Kasahara3, Vincent E De Meijer4
1Department of Surgery, Division of Transplantation, University of Alberta, Edmonton, Alberta, Canada.
Insights
Machine perfusion, particularly hypothermic oxygenated perfusion (HOPE), shows promise for pediatric liver transplantation. Early results suggest improved outcomes and reduced complications, offering hope for reducing waiting list mortality in children.
Area of Science:
- Hepatology
- Transplantation Surgery
- Pediatric Gastroenterology
Background:
- End-stage liver disease in children necessitates liver transplantation, but waiting list mortality remains high, especially for infants.
- Graft availability is limited by donor factors like age and BMI, and prolonged cold ischemia time.
- Machine perfusion techniques have demonstrated benefits in adult liver transplantation, improving postoperative outcomes and graft survival.
Purpose of the Study:
- To review the current status and potential of machine perfusion techniques in pediatric liver transplantation.
- To highlight the role of hypothermic oxygenated perfusion (HOPE) as the primary perfusion method used in pediatric liver grafts.
- To emphasize the need for further research and collaboration to optimize perfusion strategies for pediatric liver recipients.
Main Methods:
- Review of existing literature on machine perfusion in liver transplantation, with a focus on pediatric applications.
- Analysis of early clinical experiences with hypothermic oxygenated perfusion (HOPE) in pediatric liver transplant recipients, including full-size and split grafts.
- Discussion of the impact of donor characteristics and preservation methods on graft outcomes.
Main Results:
- Hypothermic oxygenated perfusion (HOPE) has been utilized in a limited number of pediatric liver transplants, including grafts from donors after circulatory death and split liver grafts.
- Early reports, including a series of split liver procedures, indicate excellent results with HOPE, characterized by reduced complications and enhanced graft survival.
- Machine perfusion in general shows advantages over static cold storage in adult liver transplantation, with potential applicability to pediatric cases.
Conclusions:
- Hypothermic oxygenated perfusion (HOPE) represents a promising advancement in pediatric liver transplantation, offering improved outcomes and reduced complications.
- Further systematic investigation and collaborative efforts are crucial to establish the efficacy of various machine perfusion techniques for different graft types in this vulnerable population.
- Optimizing perfusion strategies holds the potential to significantly impact immediate posttransplant success and long-term graft survival in children requiring liver transplants.
Abstract:
Liver transplantation is the only life-saving procedure for children with end-stage liver disease. The field is however heterogenic with various graft types, recipient age, weight, and underlying diseases. Despite recently improved overall outcomes and the expanded use of living donors, waiting list mortality remains unacceptable, particularly in small children and infants. Based on the known negative effects of elevated donor age, higher body mass index, and prolonged cold ischemia time, the number of available donors for pediatric recipients is limited. Machine perfusion has regained significant interest in the adult liver transplant population during the last decade. Ten randomized controlled trials are published with an overall advantage of machine perfusion techniques over cold storage regarding postoperative outcomes, including graft survival. The concept of hypothermic oxygenated perfusion (HOPE) was the first and only perfusion technique used for pediatric liver transplantation today. In 2018 the first pediatric candidate received a full-size graft donated after circulatory death with cold storage and HOPE, followed by a few split liver transplants after HOPE with an overall limited case number until today. One series of split procedures during HOPE was recently presented by colleagues from France with excellent results, reduced complications, and better graft survival. Such early experience paves the way for more systematic use of machine perfusion techniques for different graft types for pediatric recipients. Clinical reports of pediatric liver transplants with other perfusion techniques are awaited. Strong collaborative efforts are needed to explore the effect of perfusion techniques in this vulnerable population impacting not only the immediate posttransplant outcome but the development and success of an entire life.
