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Updated: Jul 17, 2026
Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion
Published on: April 27, 2015
Donation after circulatory death; cholangiopathy in the machine age
Ian S Currie1,2,3, Fiona M Hunt1,2,3
1Edinburgh Transplant Centre.
Insights
Machine perfusion strategies like Normothermic Regional Perfusion and Hypothermic Machine Perfusion effectively reduce liver transplant cholangiopathy in donation after circulatory death grafts. Further research is needed for other perfusion methods.
Area of Science:
- Hepatology
- Transplantation Surgery
- Organ Preservation
Background:
- Donation after circulatory death (DCD) liver transplantation faces challenges with post-transplant cholangiopathy.
- Cholangiopathy significantly impacts patient outcomes, leading to re-transplantation and mortality.
- Machine perfusion is an evolving strategy to mitigate DCD liver graft injury.
Purpose of the Study:
- To review current evidence on machine perfusion techniques for reducing cholangiopathy in DCD liver grafts.
- To evaluate the effectiveness of different machine perfusion strategies in mitigating transplant cholangiopathy.
- To identify optimal machine perfusion approaches for DCD liver transplantation.
Main Methods:
- Systematic review of published literature on machine perfusion of DCD liver grafts.
- Analysis of studies focusing on transplant cholangiopathy as a primary outcome.
- Evaluation of Normothermic Regional Perfusion (NRP), Hypothermic Machine Perfusion (HMP), and Normothermic Machine Perfusion (NMP).
Main Results:
- Normothermic Regional Perfusion and Hypothermic Machine Perfusion consistently reduce cholangiopathy rates.
- Efficacy of Normothermic Machine Perfusion at donor or recipient centers is less established.
- Combined hypothermic followed by normothermic perfusion shows promising advantages.
Conclusions:
- Donor center NRP and recipient center HMP are currently best supported for reducing DCD cholangiopathy.
- Involvement of warm perfusion techniques may improve graft utilization.
- Further investigation into novel perfusion strategies is warranted.
Purpose Of Review:
Published work evaluating machine perfusion of DCD (donation after circulatory death) liver grafts in situ and ex situ is rapidly evolving, with several landmark studies published in the last 6 months. The central question in DCD liver transplant remains; which strategies most effectively reduce cholangiopathy? This condition, which results in repeated hospital admissions, interventions, re-transplantation and death, is a major deterrent to DCD utilization. This review considers current evidence in the mitigation of transplant cholangiopathy by machine perfusion in DCD liver grafts.
Recent Findings:
Studies which directly address DCD cholangiopathy as a primary outcome are few in number, despite their critical importance. In systematic reviews, Normothermic Regional Perfusion and Hypothermic Machine Perfusion consistently and significantly reduce transplant cholangiopathy rates. By contrast, the efficacy of Normothermic Machine Perfusion performed at donor or recipient centres is less well described and cautious interpretation is required. The most recent development, namely hypothermic followed by normothermic perfusion, has only now appeared in the literature but appears to offer advantages compared to either technology alone.
Summary:
To reduce DCD cholangiopathy, current data best support the use of donor centre NRP or recipient centre HMP. However, utilization is also improved when warm perfusion is involved.
