Organ preservation: current limitations and optimization approaches
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Updated: May 15, 2025
Technique of Subnormothermic Ex Vivo Liver Perfusion for the Storage, Assessment, and Repair of Marginal Liver Grafts
Published on: August 13, 2014
Qiulin Ran1, Jiayi Zhang2, Jisheng Zhong1
1Department of Cardiovascular Surgery, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Abstract:
Despite the annual rise in patients with end-stage diseases necessitating organ transplantation, the scarcity of high-quality grafts constrains the further development of transplantation. The primary causes of the graft shortage are the scarcity of standard criteria donors, unsatisfactory organ preservation strategies, and mismatching issues. Organ preservation strategies are intimately related to pre-transplant graft viability and the incidence of adverse clinical outcomes. Static cold storage (SCS) is the current standard practice of organ preservation, characterized by its cost-effectiveness, ease of transport, and excellent clinical outcomes. However, cold-induced injury during static cold preservation, toxicity of organ preservation solution components, and post-transplantation reperfusion injury could further exacerbate graft damage. Long-term ex vivo dynamic machine perfusion (MP) preserves grafts in a near-physiological condition, evaluates graft viability, and cures damage to grafts, hence enhancing the usage and survival rates of marginal organs. With the increased use of extended criteria donors (ECD) and advancements in machine perfusion technology, static cold storage is being gradually replaced by machine perfusion. This review encapsulates the latest developments in cryopreservation, subzero non-freezing storage, static cold storage, and machine perfusion. The emphasis is on the injury mechanisms linked to static cold storage and optimization strategies, which may serve as references for the optimization of machine perfusion techniques.
Insights
Organ transplantation faces graft shortages due to preservation issues. Machine perfusion (MP) offers a promising alternative to static cold storage (SCS) for improving graft viability and transplant outcomes.
Area of Science:
- Transplantation immunology
- Organ preservation science
- Regenerative medicine
Background:
- Graft scarcity limits organ transplantation, driven by donor limitations, preservation challenges, and immunologic mismatch.
- Current static cold storage (SCS) faces limitations including cold-induced injury, solution toxicity, and exacerbation of reperfusion injury.
- Marginal organs and extended criteria donors (ECD) present challenges for traditional preservation methods.
Purpose of the Study:
- To review advancements in organ preservation techniques, focusing on static cold storage (SCS) and dynamic machine perfusion (MP).
- To elucidate injury mechanisms associated with SCS and explore optimization strategies.
- To highlight the potential of MP in enhancing graft utilization and post-transplant outcomes.
Main Methods:
- Comprehensive literature review of organ preservation strategies, including cryopreservation, subzero non-freezing storage, SCS, and MP.
- Analysis of injury mechanisms inherent to SCS.
- Evaluation of MP technologies and their benefits for graft viability and repair.
Main Results:
- SCS, while cost-effective, can induce cold injury and fails to address reperfusion damage.
- Dynamic machine perfusion (MP) preserves organs in a near-physiological state, allowing for viability assessment and damage repair.
- MP is increasingly adopted, especially for ECDs, offering improved outcomes compared to SCS.
Conclusions:
- Advancements in MP technology are crucial for overcoming limitations of SCS and improving organ transplant success.
- Understanding SCS injury mechanisms can inform the optimization of MP protocols.
- MP holds significant promise for expanding the donor pool and enhancing graft survival rates.
