The liver reconditioning in critical care medicine

Machine perfusion has emerged as a transformative alternative to static cold storage in liver transplantation, necessitating a comprehensive review of current evidence. This article examines recent advances in preservation techniques, therapeutic applications, and future directions of machine perfusion technologies.

Clinical trials demonstrate superior outcomes with machine perfusion compared with conventional preservation, particularly for marginal and donation after circulatory death grafts. Different protocols - hypothermic, subnormothermic, and normothermic perfusion - show specific advantages in various clinical settings. Technology enables therapeutic interventions like defatting steatotic livers and administering cell-based therapies. Advanced monitoring systems allow real-time graft function assessment, supporting evidence-based acceptance decisions. Novel developments include artificial intelligence applications, new perfusion solutions, and blockchain technology for standardization.

Machine perfusion represents a significant advancement in liver transplantation, though implementation challenges remain regarding infrastructure, training, and costs. The technology's ability to optimize marginal grafts and enable therapeutic interventions may expand the donor pool. Future research should focus on standardizing protocols, developing cost-effective solutions, and validating emerging technologies for widespread clinical adoption.