Liver Machine Perfusion: Past, Present and Future Directions

Liver transplantation represents the only curative method for end-stage liver disorders and certain liver malignancies. Over the last three decades, advancements in immunosuppression, surgical technique, and intensive care measures have resulted in improved patient and graft survival outcomes, but a deficit of donor organs is constantly the major issue that limits our ability to reduce the mortality on the liver transplant waiting list. To address this, marginal grafts and those from donors after cardiac death are increasingly employed, but these strategies necessitated novel methods to improve the preservation and quality of liver grafts and the most promising one is liver machine perfusion (LMP). LMP evolved significantly in the past 10 years, and consequently, it is gradually establishing itself as a standard protocol at many transplant centers. However, many unresolved questions remain concerning the indications, types, and protocols associated with LMP. Therefore, continuous research is necessary to determine optimal guidelines and recommendations for its clinical application. This review aims to analyze the development of liver machine perfusion, including its different modalities underlying mechanisms of operation, and provide an overview of its historical evolution, current status, and future prospects.