Simplified ischemia-free liver transplantation with continuous normothermic machine perfusion

The persistent disparity between organ donation rates and clinical demand has driven the increasing use of extended-criteria donor livers. However, conventional static cold storage inadequately preserves extended-criteria donor with severe ischemia-reperfusion injury (IRI), contributing to high rates of mortality and morbidity. Although different machine perfusion technologies have been used to reduce IRI in clinical practice, organ ischemia remains unavoidable throughout the entire transplantation procedure. To minimize IRI to the greatest extent possible, we developed a novel ischemia-free liver transplantation (IFLT) method based on surgical innovation and continuous normothermic machine perfusion. IFLT not only effectively preserves graft quality but also expands the donor pool, making it possible to utilize high-risk livers. Classic IFLT increases the complexity of donor liver procurement and prolongs the anhepatic phase during implantation. Here we develop a simplified IFLT (SIFLT) technique. By streamlining the donor liver retrieval procedure and optimizing the sequence of vascular anastomosis during implantation, the efficacy and safety data for SIFLT are comparable to those of classic IFLT, with similar rates of postoperative complications, graft survival and patient survival. Thus, SIFLT represents a more efficient, safer and widely applicable approach to minimize organ ischemia, offering a robust strategy to improve outcomes and maximize organ utilization.