Liver transplantation: embracing the future with machine perfusion

Area of Science:

• Hepatology
• Transplant Surgery
• Organ Preservation Technology

Background:

• A persistent donor-recipient disparity challenges liver transplantation.
• Extended criteria donor grafts are often underutilized.
• Ischemia-reperfusion injury and graft dysfunction are significant post-transplant complications.

Purpose of the Study:

• To evaluate machine perfusion as a method for improving liver graft preservation.
• To assess the potential of machine perfusion to expand the donor pool and reduce waitlist times.
• To identify challenges in implementing machine perfusion programs in specific healthcare systems, such as Brazil.

Main Methods:

• Ex vivo machine perfusion using hypothermic or normothermic modes.
• Continuous supply of oxygen and nutrients to maintain cellular metabolism.
• Utilizing extended criteria donor grafts for transplantation.

Main Results:

• Machine perfusion helps prevent ischemia-reperfusion injury, early graft dysfunction, and ischemic cholangiopathy.
• This technique is expected to reduce rejection rates and increase the utilization of available liver grafts.
• Implementation in Brazil faces unique challenges including healthcare access, waiting lists, donor support, donor type limitations, and geography.

Conclusions:

• Ex situ perfusion machines offer a promising approach to increase liver graft usage and shorten transplant waiting lists.
• Careful evaluation of the cost-effectiveness of machine perfusion technology is necessary.
• Specific healthcare system factors in countries like Brazil require tailored strategies for successful machine perfusion program implementation.