Advanced Machine-Assisted Liver Reconditioning in Critical Care

Area of Science:

• Hepatology
• Transplantation Surgery
• Biomedical Engineering

Background:

• Liver transplantation (LT) faces challenges with ischemia-reperfusion injury (IRI) and donor organ shortage.
• Marginal grafts from extended criteria donors (ECD) and donation after circulatory death (DCD) are increasingly used but are more susceptible to IRI.

Purpose of the Study:

• To review machine perfusion (MP) technologies for liver graft preservation and utilization in LT.
• To evaluate hypothermic, subnormothermic, and normothermic MP in comparison to static cold storage (SCS).

Main Methods:

• Review of current literature on machine perfusion (MP) technologies in liver transplantation (LT).
• Evaluation of hypothermic machine perfusion (HMP), oxygenated HMP (HOPE), subnormothermic perfusion, and normothermic machine perfusion (NMP).

Main Results:

• HOPE shows protective effects on the biliary system and may reduce ischemic injury.
• Normothermic machine perfusion (NMP) demonstrates reduced early allograft dysfunction and increased use of marginal grafts in clinical trials.
• Combined techniques like HOPE followed by NMP may offer synergistic benefits.

Conclusions:

• Machine perfusion (MP) technologies represent a significant advancement in liver transplantation (LT).
• NMP is promising for functional assessment and extended preservation, while HOPE is valuable for reconditioning.
• Further large-scale trials are needed to establish MP as a standard LT protocol.