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Updated: Jun 30, 2026
Ex Situ Normothermic Machine Perfusion of Donor Livers
Published on: May 26, 2015
The Role of Machine Perfusion for Liver Transplantation in Children
Sapana Verma1,2, Maria Baimas George3, George Mazariegos4
1Transplantation Center, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Insights
Pediatric liver transplantation (PLT) faces challenges, especially in infants. Hypothermic oxygenated perfusion (HOPE) shows promise in improving outcomes for pediatric liver transplants, reducing complications and graft loss.
Area of Science:
- Hepatology
- Transplantation Surgery
- Pediatric Surgery
Background:
- Pediatric liver transplantation (PLT) is critical for children with end-stage liver disease but faces challenges like procedural complexity and high waitlist mortality, particularly in infants.
- Limited donor availability and higher complication risks necessitate improved strategies for evaluating and optimizing donor liver quality before implantation.
Purpose of the Study:
- To review the current evidence and highlight the need for further research on machine perfusion techniques, specifically hypothermic oxygenated perfusion (HOPE) and normothermic machine perfusion (NMP), in pediatric liver transplantation.
- To assess the impact of HOPE and NMP on transplant outcomes in pediatric recipients, especially when utilizing extended criteria donors or split grafts.
Main Methods:
- Review of clinical studies and case series reporting the use of machine perfusion in pediatric liver transplantation.
- Analysis of the efficacy of HOPE in reducing early graft dysfunction, biliary complications, and graft loss post-PLT.
Main Results:
- Hypothermic oxygenated perfusion (HOPE) has demonstrated efficacy in reducing early graft dysfunction, biliary complications, and graft loss in pediatric liver transplantation.
- Evidence for normothermic machine perfusion (NMP) in pediatric liver transplantation remains scarce, indicating a need for more research.
Conclusions:
- HOPE is a promising tool that has shown benefits in improving outcomes for pediatric liver transplantation.
- Coordinated research is essential to fully understand the effects of HOPE and NMP on pediatric transplant outcomes, particularly with expanded donor criteria and DCD grafts.
Abstract:
Pediatric liver transplantation (PLT) is the only lifesaving procedure for children with advanced liver disease and tumors. Despite significant progress and overall success in PLT, the field continues to face challenges due to procedural complexity across a heterogeneous age group, especially in infants and small children. Despite the use of living donor grafts, waitlist mortality remains disproportionately high in these younger patients. The unique challenges in PLT-including limited donor availability and higher risk of complications-underscore the need for improved strategies to evaluate and optimize donor liver quality before implantation. Machine perfusion has emerged as a promising tool in this context. While the benefits of hypothermic oxygenated perfusion (HOPE) for whole and partial livers have been reported with applications during and after liver split, the evidence for normothermic machine perfusion (NMP) remains scarce. Since the first report in 2019, multiple case series and clinical studies support the efficacy of HOPE in reducing early graft dysfunction, biliary complications, and graft loss after liver transplantation in children. Despite this progress, there is a pressing need for coordinated research efforts to study how HOPE and NMP affect transplant outcomes in pediatric recipients, especially when expanding split criteria or using DCD grafts, which are vital for expanding the donor pool despite the known higher risk.
